Clinicopathologic Characteristics and Prognostic Factors Impacting Survival in Melanoma of the Eyelid: Running Title: Prognostic Factors for Survival in Melanoma of the Eyelid.

PURPOSE: To examine prognostic factors for survival in patients with melanoma of the eyelid.

DESIGN: Retrospective cohort analysis SETTING: Population-based study STUDY POPULATION: Patients with primary melanoma of the eyelid diagnosed in the Surveillance, Epidemiology and End Results database between 1975 and 2016.

MAIN OUTCOMES MEASURES: Survival rates estimated by Kaplan-Meier analysis and mortality hazard ratios(HRs) for overall survival(OS) and disease-specific survival(DSS).

RESULTS: The cohort consisted of 2257 patients with cutaneous melanoma in the eyelid, representing 1380 cases of melanoma in situ and 877 cases of invasive melanoma. For melanoma in situ and invasive melanoma respectively, at 5-years, the OS rates were 88.6% and 77.1%, while DSS rates were 99.4% and 91.0%. Cox regression analysis for eyelid melanoma indicated that for invasive melanoma, age at diagnosis ≥ 75 years [HR 2.17; 95% confidence interval(CI) (1.02-4.60); p = 0.04], T4 staging (HR 8.45; 95% CI 2.96-25.31; p < 0.001), lymph node involvement (HR 3.61, 95% CI 1.12 - 11.60; p = 0.03), and nodular melanoma (HR 3.31; 95% CI 1.50-7.32; p = 0.003) histological subtype were associated with decreased rates of survival. Sex and tumor ulceration did not impact survival.

CONCLUSIONS: This study is the largest analysis to date that focuses on DSS for cutaneous melanoma of the eyelid. The most significant predictors for invasive melanoma survival are age 75 years or greater at diagnosis, T4 staging, lymph node involvement, and the nodular melanoma histological subtype. Patients with these attributes are at higher risk and should be counseled regarding prognosis.