Recurrent lentigo maligna melanoma of the lower eyelid: multiple flaps that work.
Author: Tomislav Sarenac
Base Hospital / Institution: Department of Ophthalmology, University Medical Center Maribor, Slovenia
ePoster presentation
Abstract ID: 25-583
Purpose
Herein we present a clinical case of surgical treatment of a patient with recurrent lentigomalignant melanoma of the lower eyelid. A 86-year-old female patient diagnosed with lentigo malignant melanoma ofthe lower eyelid was first treated by plastic surgeons. At the time, the lesion was excised with healthy margins and reconstruction was performed with a Y-flap. Four years later, a recurrence occurred, and the patient was referred to our department.
Methods
The lower eyelid was initially treated with excision of the lesion with healthy margins, using frozen section; The posterior lamella was preserved. Reconstruction followed with a cheek island rotational flap, and a free skin graft transplantation; After the melanoma recurrence, excision of the lesion with healthy margins and a subsequent reconstruction with a Hughes flap, and free skin graft transplantation was performed at the same site.
Results
One year after the first surgery the reconstruction was successful with an excelent functional and good aesthetic result. The melanoma recurred again in 2 years, this time extending to the Meibomian glands. A radical excision of the entire eyelid including the posterir lamella, with wide safety margins was performed, followed by a Hughes flap from the upper eyelid. This is a two-phase procedure, where the flap is severed in the second phase. After several months of recovery, the patient has a good functional and aesthetic outcome of the eyelid. One year follow-up showed no signs of recurrence. The ocular surface and visual acuity were fully preserved.
Conclusion
This case demonstrates the complexity of treating malignant melanoma of the eyelids. Despite the fact that all histological findings of the excised lesions showed clear margins, the disease can recur at the adjacent site. Regular monitoring is essential. With this case, it was apparent that a complex surgical procedure at the same site can follow initial reconstructive surgery when an appropriate flap is used, leading to a good result and ultimately stable quality-of-life outcomes.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Matija | Šparaš | Department of Ophthalmology, University Medical Center Maribor, Slovenia |
