Management of Periocular Cutaneous Melanoma with a Staged Excision Technique and Permanent Sections: The Square Procedure
Presented at: American Academy of Ophthalmology Annual Meeting, October 2005, Chicago, Illinois.
Received 30 August 2007; received in revised form 6 June 2008; accepted 6 June 2008. published online 11 August 2008.
Objective
To evaluate the outcome of the square procedure, a multidisciplinary, staged excision technique using standard formalin-fixed, vertically oriented sections for periocular cutaneous melanoma.
Design
Observational, retrospective, case series.
Participants
Forty patients with periocular cutaneous melanoma treated with the square procedure.
Methods
Demographic features, tumor data, and recurrence rate were reviewed retrospectively for 40 patients with periocular cutaneous melanoma treated with the square procedure.
Main Outcome Measure
Local recurrence rate.
Results
Of 40 patients, 26 (65%) had lentigo maligna melanoma in situ (MIS), 12 (30%) had lentigo maligna melanoma, and 2 (5%) had superficial spreading melanoma. Tumor-free margins were reached within a mean margin of 13 mm for patients with MIS and of 16 mm for patients with invasive melanoma. There was no statistical difference for the margin width in patients with MIS and invasive melanoma. The lesion size and margin width were significantly correlated. Recurrence was observed in 1 (2.5%) patient at 8 months after the square procedure, and a Kaplan-Meier survival curve estimated a local recurrence rate of 2.5% at 8 years.
Conclusions
The square procedure is an effective procedure for management of periocular lentigo maligna melanoma in situ and lentigo maligna melanoma with a low local recurrence rate of 2.5% at 8 years.
Financial Disclosure(s)
The authors have no proprietary or commercial interest in any materials discussed in this article.
Available online: August 9, 2008.
1Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
2Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan
3Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
4Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan
5Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan
6Department of Epidemiology, University of Michigan Medical School, Ann Arbor, Michigan
Correspondence: Christine C. Nelson, MD, University of Michigan, W. K. Kellogg Eye Center, 1000 Wall Street, Ann Arbor, MI 48105
Manuscript no. 2007-1130.
Financial Disclosure(s): No conflicting relationship or funding support exists for any author.
ABSTRACT