Oculoplastics

46 3 Eyelid Neoplasms

MALIGNANT MELANOMA M alignant melanoma is a rare but very dangerous malignant lesion of the eye lids. Sun exposure in childhood is an etiologic factor. Despite aggressive surgical excision, this can still be a fatal tumor. Epidemiology and Etiology ● Age: Third decade and beyond ● Gender: Equal between males and females ● Etiology: Sun exposure and genetic predisposition History ● Pigmented lesion with recent growth or change in appearance Examination ● Pigmented lesion with irregular pigment deposition, irregular margins, or just increase in size ( Fig. 3-7 ) ● There may be ulceration and bleeding. Differential Diagnosis ● Nevus ● Pigmented basal cell carcinoma

Laboratory Tests ● Specimens are sent for pathologic evaluation. Treatment ● Complete excision with aggressive, con trolled surgical margins ● Frozen sections for margin control have limited value in a melanoma. ● The deeper the lesion, the wider the mar gins required. ● Sentinel lymph node biopsy is usually required. ● Melanomas are best excised via a team ap proach at centers experienced with melanoma treatment. Prognosis ● Dependent on the depth of the tumor, spread to nodes or metastasis ● Five-year survival rate is improving.

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