Prognostic factors for survival in malignant melanoma of the eyelid skin

Purposes This study aimed to determine the prognostic factors for survival and disease-free interval for malignant melanoma of the eyelid skin. Methods: This was a retrospective, nonrandomized, clinical review. Twenty-f our patients with eyelid skin melanoma were identified through a search of the tumor registry at M. D. Anderson Cancer Center Patients were treated be tween 1953 and 1994. The follow-vp ranged from 3 to 18 years (mean = 9.6 ye ars). Primary treatment in all cases entailed wide local excision of the tu mor. Patients in whom regional lymph node metastasis developed underwent pa rotidectomy or neck dissection, with or without adjuvant chemotherapy or ex ternal beam radiation. Descriptive statistics were used to characterize the patients. Survival analysis in terms of disease-free survival and recurren ce-free survival was performed using age, sex, location of tumor (upper lid , lower lid, or both), histologic type of melanoma, Breslow thickness, and Clark's level as independent variables for survival. Results: Age, sex, location, and the histologic type of tumor were not sign ificant prognostic indicators for survival in this cohort. Clark's level gr eater than or equal to IV by itself was a statistically significant predict or of decreased survival. In addition, tumors with either Clark's level gre ater than or equal to IV or Breslow thickness greater than or equal to 1.5 mm were associated with increased mortality. Conclusion: Clark's level greater than or equal to IV or Breslow thickness greater than or equal to 1.5 mm are poor prognostic indicators for malignan t melanomas of the eyelid skin. Clinicians should have a high level of susp icion for occult regional lymph node metastasis when treating patients with these tumor features.