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首页> 外文期刊>Journal of plastic, reconstructive & aesthetic surgery: JPRAS >Margins of excision and prognostic factors for cutaneous eyelid melanomas
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Margins of excision and prognostic factors for cutaneous eyelid melanomas

机译：皮肤眼睑黑色素瘤的切除范围和预后因素

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Background Guidelines for wide excision of cutaneous melanomas according to Breslow thickness are impractical when considering melanomas arising on eyelid skin. No consensus exists regarding appropriate excision margins for these tumours. This study sought to determine whether excision margins influenced locoregional recurrence, and to identify prognostic factors for survival in these patients. Methods Fifty-six cases of invasive cutaneous eyelid melanomas diagnosed between 1985 and 2011 were identified from the database of Melanoma Institute Australia. Clinical and pathological factors were assessed for their associations with recurrence and survival. Results Local recurrence occurred in 12 patients (21%), nodal metastasis in 6 (11%) and distant metastasis in 2 (4%). Pathological margins >2 mm from the in situ component of the tumour were associated with increased disease-free survival (P = 0.029) compared with margins ≤2 mm but there was no statistically significant benefit for a pathological margin >2 mm from the invasive component. Lower eyelid melanomas were found to have a significantly higher local recurrence rate than upper eyelid melanomas (P = 0.044). Conclusions This series of cutaneous eyelid melanomas is the largest yet reported. The results suggest that, as a minimum, an in vivo surgical margin of 3 mm (corresponding to a 2 mm pathological margin after tissue fixation) is desirable for eyelid melanomas. We recommend a surgical excision margin of 3 mm for eyelid melanomas ≤1 mm in Breslow thickness. However, for melanomas >1 mm in thickness, the current practice of aiming to achieve 5 mm margins would seem reasonable. Patients with lower eyelid melanomas warrant particularly close follow-up given their higher local recurrence rate.
机译：背景技术当考虑到眼睑皮肤上产生的黑色素瘤时，根据Breslow厚度广泛切除皮肤黑色素瘤的指南是不切实际的。对于这些肿瘤的适当切除余量尚无共识。这项研究试图确定切除边缘是否影响局部复发，并确定这些患者生存的预后因素。方法从澳大利亚黑色素瘤研究所的数据库中鉴定出1985年至2011年间诊断出的56例浸润性皮肤眼睑黑色素瘤病例。评估临床和病理因素与复发和生存的关系。结果局部复发12例（21％），淋巴结转移6例（11％），远处转移2例（4％）。与≤2 mm的切缘相比，距肿瘤原位部分> 2 mm的病理切缘与无病生存期增加（P = 0.029）相关，但从浸润的切缘> 2 mm的病理切缘无统计学意义的获益。发现下眼睑黑素瘤的局部复发率明显高于上眼睑黑素瘤（P = 0.044）。结论这一系列皮肤眼睑黑色素瘤是迄今报道的最大的。结果表明，对于眼睑黑素瘤，至少需要3 mm的体内手术切缘（相当于组织固定后2 mm的病理切缘）。对于Breslow厚度≤1 mm的眼睑黑色素瘤，我们建议手术切缘为3 mm。但是，对于厚度> 1 mm的黑素瘤，目前的目标是达到5 mm的余量似乎是合理的。鉴于下眼睑黑色素瘤患者局部复发率较高，因此需要特别密切随访。

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