Invasive Cutaneous Melanoma of the Eyelid

A patient presented to clinic for a long-standing history of a left lower eyelid/ cheek lesion with more recent growth. He had a history of multiple previously resected basal cell carcinomas of the face, neck and scalp. Initial examination was notable a left lower and upper eyelid lesion with heterogenous pigment and asymmetric configuration which extended to the cheek area measuring roughly 2 – 3cm, no palpable lymph nodes were felt on examination. Biopsy was expedited and revealed an invasive melanoma of the cheek on the area of more prominent pigment Breslow 0.6mm, and Slow Mohs was performed on two occasions proving unsuccessful with continuous positive margins and areas of melanoma with q maximal depth of 0.7mm, and no ulceration on pathology. Mohs surgery was attempted next, and it achieved margin clearance. The surgical area was reconstructed with a combination of full thickness skin grafts from the supraclavicular, retro auricular and inner braquial area aided by a lateral permanent tarsorrhaphy. No extensive imaging or sentinel node biopsy were deemed necessary, due to surgical clearance no complementary therapy was proposed. The patient has achieved a good surgical outcome and continuous in surveillance. The case highlights the importance of cutaneous melanoma recognition and treatment at an early stage.

Presentation Date: 08/15/2024

Issue Date: 08/23/2024