Cutaneous Melanoma

Cutaneous melanoma of the eyelid is a rare tumor that occurs mainly in adults and older people. It may occur in the eyelid margin, involving the palpebral conjunctiva. In such cases, conjunctival melanoma as the primary site should be ruled out. Cutaneous melanoma in the eyelid is histologically like skin melanoma in other locations. Complete surgical excision of the melanoma with free surgical margins is the treatment of choice. However, the ideal width of the surgical margins in eyelid melanoma is controversial. The width of the excision margins—the amount of presumed uninvolved eyelid tissue—is constrained and often narrower than advised in other cutaneous sites. In resecting eye malignancies, the surgeon must consider the functional status of the eyelid after surgery with reconstruction. Eyelids that do not close properly and leave the cornea exposed may result in a painful eye with compromised vision. Adjuvant treatment, such as immunotherapy, is advocated in advanced and metastatic cases. Sentinel lymph node biopsy has been used in some centers.