Eyelid Melanoma
An 87-year-old man presented for treatment of a stye on his left upper eyelid. Despite conservative interventions, the stye had persisted and the skin had become noticeably darker over several weeks (Panels A and B). He reported itching but no pain or bleeding. His risk factors for skin cancer included a history of prolonged sun exposure while working as a lifeguard. A biopsy specimen from the margin of the left upper eyelid was obtained and on examination revealed invasive lentigo maligna melanoma, with a Breslow thickness of 0.35 mm, no ulceration, and no mitogenesis (Panel C, Melan-A stain). The patient was subsequently referred to the melanoma clinic for multidisciplinary management of care, but he declined treatment and was lost to follow-up. Primary melanoma of the eyelid is rare, accounting for less than 1% of cutaneous melanomas and less than 1% of malignant tumors of the eyelid. Lentigo maligna melanoma is the most common histologic subtype of melanoma involving the eyelid. The lower eyelid is more often involved than the upper eyelid, given its more direct exposure to sunlight.
