Outcomes of Facial Melanoma Surgery: An 8-Year Retrospective Study on Radicality and Recurrence

Abstract

Introduction Melanoma is a highly aggressive and life-threatening form of skin cancer, accounting for approximately 60% of skin cancer-related deaths, with its incidence steadily rising over the past century [1,2]. Early diagnosis and surgery are crucial, especially in stage 0, I, and most stage II melanomas, where complete excision with clear margins is essential to reduce recurrence risk [3]. In advanced stages, additional therapies may be needed, but surgery remains key to controlling the disease and improving survival [4]. Facial melanoma accounts for 10-15% of melanomas, but radical excision is more challenging due to the complex anatomy of the face, which requires balancing tumor removal with functional and aesthetic considerations [5,6]. Aim The study aimed to evaluate the distribution of melanoma localization on the face, their dimensions, and morphological types, as well as the degree of radicality achieved during surgical treatment. Methods The study was conducted at Kaunas Clinics, Department of Plastic and Reconstructive Surgery, where data was collected from 93 patients who underwent facial melanoma surgeries between January 1, 2016, and December 31, 2023. Statistical data analysis was performed using IBM SPSS Statistics 29.0.2.0 software. Results The study included 93 patients, 68 women (73.1%) and 25 men (26.9%), with an average age of 71 years. Most tumors were benign (77.4%) compared to malignant ones (22.6%). The most common tumor was lentigo maligna (75.2%), followed by superficial spreading melanoma (14%) and nodular melanoma (10.8%). Among all tumors, the left cheek was the most frequent facial location (45.2%). A significant correlation was found between the T criterion and melanoma morphology: Tis was most often observed in lentigo maligna, T2 in superficial spreading melanoma, and T4 in nodular melanoma (p < 0.01). Surgical radicality was significantly linked to recurrence rates (p = 0.012, χ2 = 11.673). ROC curve analysis suggested that an excision margin of at least 0.6 cm can reduce recurrence, but the optimal margin should be adjusted based on tumor thickness, with thicker tumors requiring wider excisions for clear resection. Over an 8-year period, 8 recurrences were reported: 3 within the first year, 2 within two years, 2 after three years, and 1 more than five years post-surgery. Lentigo maligna accounted for the majority of recurrences (6 cases), with one case each of nodular melanoma and superficial spreading melanoma. The most frequent adjuvant treatment following non-radical surgery or recurrence was repeated excision, used in 66.7% of cases. Conclusions Facial melanoma excision is challenging due to complex anatomy. This study found that a surgical margin of at least 0.6 cm significantly reduces recurrence, though the ideal margin may vary with tumor thickness. Clear margins and repeat excisions are essential for better long-term outcomes.