Mohs micrographic surgery versus wide local excision for eyelid melanoma: An analysis of a national database

Published:August 28, 2022DOI:



      Although eyelid melanomas represent less than 1% of eyelid neoplasms, they have the worst prognosis. Wide local excision (WLE) and Mohs micrographic surgery (MMS) are mainstay treatment options. We conducted a retrospective analysis to assess all-cause and cause-specific mortality rates in patients undergoing WLE or MMS for eyelid melanoma.


      A retrospective analysis of Surveillance, Epidemiology, and End Results (SEER) registry was performed for eyelid melanoma treated with WLE or MMS. Cases were limited to American Joint Committee on Cancer (AJCC) stage T1 primary malignancies.


      A total of 45 cases of WLE were identified along with 48 cases of MMS for eyelid melanoma. There was no significant difference between subgroups in age group, sex, race, ethnicity, marital status at diagnosis, AJCC N stage, AJCC M stage, melanoma histology, chemotherapy use, and radiotherapy use. Among the cohort, all tumors were unilateral. Kaplan–Meier analysis with log-rank demonstrated no significant difference between MMS and WLE subgroups with regard to overall survival (P = 0.662) and cancer-specific survival (P = 0.494). Cox regression adjusting for variables with α<0.10 and found no significant difference in all-cause mortality (HR, 0.923; 95% CI 0.310–2.747; P = 0.885) or cancer-specific mortality (HR, 0.518; 95% CI 0.047–5.711; P = 0.591) when patients who underwent MMS were compared to those who underwent WLE.


      While our study is limited by a small number of patients, our analysis demonstrated no significant difference in all-cause or cause-specific survival for patients with eyelid melanoma treated with MMS compared with WLE. In areas requiring preservation of tissue due to cosmetic or functional purposes, MMS is a reasonable surgical approach.


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      Linked Article

      • Managing cutaneous melanoma of the eyelid: Evidence from surveillance, epidemiology, and end results (SEER) program
        Journal of Plastic, Reconstructive & Aesthetic SurgeryVol. 75Issue 12
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          Ramachandran and Phan's investigation of Mohs Micrographic Surgery (MMS) versus Wide Local Excision (WLE) for T1 stage eyelid melanoma1 has important implications for plastic surgery. The study, based on analysis of Surveillance, Epidemiology, and End Results (SEER) Program data, found comparable overall survival and cancer-specific survival for MMS and WLE at over 5-years median follow-up. The non-inferiority of MMS is a promising result. Despite significant surgical innovation in periorbital reconstruction,2–4 the eyelid remains a high-risk site for functional and aesthetic impairments after surgery.
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