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Melanoma recurrence rate low after staged excision
Ophthalmology. 2008:115(12):2295-2300.e3.
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Only one recurrence in 40 patients was observed at 8 months after staged excision of periocular cutaneous melanoma by the square procedure.
The 40 patients were followed up in an observational, retrospective case series, which estimated the local recurrence rate to be 2.5% at 8 years.
"The necessity of surgical margin clearance by histopathologic examination is essential for prevention of local recurrence," the study authors said.
In the square procedure, narrow, geometrically shaped strips of tissue are excised and processed. If positive margins are found, further excision is done in stages until margins are clear.
Thirty-one patients (78%) had positive margins after the first square procedure, with a mean number of two procedure stages (range, one to five) needed to achieve tumor-free margins.
"We found a significant correlation between the lesion size and the margin width needed to reach tumor-free margins," the authors said.
For patients with melanoma in situ, tumor-free margins were reached at a mean of 13 mm; for patients with invasive melanoma, tumor-free margins were reached at a mean of 16 mm.
The main message is that this level of melanoma can have a low recurrence rate if done by this technique. This method requires a team of committed doctors to achieve these good results. Since there is such a good cure rate, it behooves the examining ophthalmologist to get a biopsy of a pigmented lesion that may look suspicious or is growing. Surgeons who in the past might have removed a lentigo maligna in situ with a “wide margin” might now feel it is in the patient’s best interest to be referred to a center with a team who does this procedure frequently.
– Jay J. Older, MD
OSN Oculoplastic and Reconstructive Surgery Section Member