Submitter Withdrawn Australasian Melanoma Conference 2026

The conundrum of periocular melanoma: An audit of recurrent lentigo maligna/lentigo maligna melanoma and management considerations (#304)

Alex Chamberlain 1 2 , Anneliese Willems 3 , Yonatan Kok 1 , Eldho Paul 4 , Catriona McLean 2 5 , Alan Pham 2 5 , Hugh Roberts 1 2 , Yan Pan 1 2 , Wenyuan Liu 1 , Justin Friebel 6 , Stephen Salerno 1 2 7 , Ramin Shayan 1 2 7 , Frank Bruscino-Raiola 1 2 7 , Victoria Mar 1 2 4
  1. Paula Fox Melanoma and Cancer Centre, Bayside Health, Melbourne, VIC, Australia
  2. Victorian Melanoma Service, alfred health, PRAHRAN, VIC, Australia
  3. General Practice and Primary Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
  4. School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
  5. Anatomical pathology, alfred health, PRAHRAN, VIC, Australia
  6. Orbital Plastics & Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
  7. Plastics and Reconstructive Surgery Unit, Alfred Health, PRAHRAN, VIC, Australia

Background/Aim
Lentigo maligna (LM) and lentigo maligna melanoma (LMM) commonly occur on chronically sun-damaged facial skin and can be difficult to delineate clinically and histologically. Achieving adequate surgical margins on the face—particularly in anatomically complex regions—can therefore be challenging and may increase the risk of recurrence. This study aimed to examine recurrence patterns in facial LM/LMM and determine whether specific facial subsites are associated with an increased risk of local recurrence.

Methods
A retrospective cohort study was conducted using the Victorian Melanoma Service database. Patients diagnosed with LM or LMM of the face between 2010 and 2019 were included, excluding melanomas of the scalp, ears, and neck. Tumour location was mapped using a standardized facial subsite classification. Demographic, clinicopathologic, and treatment data were collected. Local recurrence was defined as biopsy-proven LM/LMM occurring within 2 cm of the original site after treatment with curative intent. Cox proportional hazards regression was used to analyse recurrence risk, adjusting for age, sex, tumour type, laterality, histopathological margins, and facial subsite.

Results
A total of 570 patients with facial LM/LMM were identified (median age 68 years; 50.9% female). Most tumours were LM (77.2%), with LMM comprising 22.8%. The cheek was the most common site (60.2%), followed by the nose (15.6%) and periocular region (9.3%). Overall recurrence occurred in 13.9% of cases. Although periocular tumours represented a small proportion of cases, they accounted for a disproportionately high number of recurrences, with approximately one-third recurring. Recurrence occurred earlier in periocular lesions (median 48.8 months) compared with cheek lesions (108.5 months). On multivariate analysis, periocular location (HR 2.60, 95% CI 1.37–4.95) and histopathological margins <5 mm (HR 1.79, 95% CI 1.04–3.09) were independent predictors of recurrence.

Conclusions
Periocular LM/LMM carries a significantly higher risk of local recurrence compared with other facial subsites. These findings highlight the importance of careful surgical planning and consideration of margin-controlled approaches, along with non-surgical therapies for melanomas in this anatomically challenging region. Case examples will be used to highlight these challenges.