In the United States alone, more than 100,000 people are diagnosed with cutaneous melanoma each year. One in 50 cases affecting the head and neck region is primary eyelid melanoma, and recently, researchers set out to determine survival rates and predictors for both in situ and invasive forms of the condition. They found that the overall survival rates were 88.6% and 77.1%, respectively, while disease-specific survival (DSS) rates were 96.5% and 93.5%, with several survival predictors identified for invasive melanoma.

This population-based study observed data from 2,257 patients with cutaneous melanoma in the eyelid diagnosed in the Surveillance, Epidemiology and End Results database between 1975 and 2016. Of all the cases, 1,380 were melanoma in situ and 877 were invasive melanoma, with mean ages of diagnosis of 67 and 64.8 years, respectively. 

For invasive melanoma, the multiple factors associated with decreased rates of survival included age of 75 years or greater at diagnosis, T4 staging, lymph node involvement and nodular melanoma histological subtype. Conversely, race, sex, ulceration, year of diagnosis and treatment modality were not associated with DSS. For melanoma in situ, the only predictor of DSS was radiation therapy. However, it’s important to note that radiotherapy is commonly recommended for patients unable to have surgery because of advanced age, comorbidities or cosmetic or functional reasons. 

The most common histological subtypes observed for invasive melanoma were lentigo maligna melanoma (20.9%), superficial spreading melanoma (20.0%) and nodular melanoma (8.1%). “With the exception of nodular melanoma, which was associated with poorer DSS in invasive melanoma, this study found that for the majority of histological subtypes, there was no impact on OS or DSS for either eyelid melanoma in situ or invasive melanoma,” authors of the study explained. 

Consider your invasive melanoma patients 75 years or older at diagnosis who have T4 staging, lymph node involvement or the nodular melanoma subtype to be at higher risk, along with in situ patients who have undergone radiation therapy.

Go CC, Kim DH, Go BC, et al. Clinicopathologic characteristics and prognostic factors impacting survival in melanoma of the eyelid. Am J of Ophthalmol. July 26, 2021. [Epub ahead of print].