Corneoplastic department, Queen Victoria Hospital, East Grinstead, UK.
Eye (Lond). 2023 Apr;37(5):1009-1013. doi: 10.1038/s41433-023-02428-9. Epub 2023 Feb 24.
To provide evidence for long-term outcomes for margin-controlled excision of eyelid melanoma.
Retrospective single-centre observational case series of patients treated for eyelid melanoma between 2007 and 2016, with a minimum of 5-year follow-up. Tumour excision involved rush-paraffin en face horizontal sections and delayed repair (Slow Mohs; SM).
Twenty-two cases were seen with a survival of 91% (two deaths from nodular and lentigo maligna melanoma) and seven with melanoma in situ (MIS). Invasive melanoma includes eight lentigo maligna melanoma, four nodular, two amelanotic and one desmoplastic. Mean Breslow thickness was 6 mm for invasive (range 0.5-26). Mean excision margin for MIS was 3 mm (range 2-5 mm) and for invasive was 5 mm (range 2-10). Further excisions were performed in nine (41%); two went on to recur. Local recurrence was 36%; six invasive (27%) at a mean of 24 months (range 1.5-5 years) and two for MIS at a mean of 15 months (range 1-1.5 years). Imaging occurred for suspected advanced disease. Sentinel node biopsy was not performed. Advanced melanoma therapy was performed in two cases. No vitamin D testing occurred.
Survival rates are in line with 90% overall survival in the UK. Prescriptive excision margins are not applicable in the periocular region and margin-controlled excision with a delayed repair is recommended, but patients need to know further excision may be needed to obtain clearance. Evidence recommending vitamin D therapy needs to be put into clinical practice. In addition, upstaging of MIS occurred advocating excision rather than observation of MIS. More studies are needed to determine the best management of eyelid melanoma.
为眼睑黑色素瘤的边缘控制切除术的长期结果提供证据。
回顾性单中心观察性病例系列，纳入 2007 年至 2016 年间接受眼睑黑色素瘤治疗的患者，随访时间至少 5 年。肿瘤切除涉及快速石蜡面水平横切和延迟修复（Slow Mohs；SM）。
共观察到 22 例患者，存活率为 91%（2 例死于结节性和恶性雀斑黑色素瘤），7 例原位黑色素瘤（MIS）。侵袭性黑色素瘤包括 8 例恶性雀斑样黑色素瘤、4 例结节性黑色素瘤、2 例无色素性黑色素瘤和 1 例促结缔组织增生性黑色素瘤。侵袭性黑色素瘤的平均 Breslow 厚度为 6mm（范围 0.5-26）。MIS 的平均切除边缘为 3mm（范围 2-5mm），侵袭性黑色素瘤的平均切除边缘为 5mm（范围 2-10mm）。9 例（41%）进行了进一步切除，其中 2 例复发。局部复发率为 36%；6 例侵袭性黑色素瘤（27%）平均复发时间为 24 个月（范围 1.5-5 年），2 例 MIS 平均复发时间为 15 个月（范围 1-1.5 年）。进行影像学检查是为了怀疑发生晚期疾病。未进行前哨淋巴结活检。2 例患者接受了晚期黑色素瘤治疗。未进行维生素 D 检测。
生存率与英国总体生存率 90%一致。在眼眶周围区域，规定性切除边缘并不适用，建议进行边缘控制切除和延迟修复，但患者需要知道可能需要进一步切除以获得清除。需要将推荐维生素 D 治疗的证据应用于临床实践。此外，MIS 的升级提倡进行切除而不是观察 MIS。需要进一步研究以确定眼睑黑色素瘤的最佳治疗方法。
