Melanoma

Melanomas represent less than 1% of malignant eyelid tumours (Figure 6.7). Pigmented BCCs are ten times more common than melanoma as a cause of pigmented eyelid tumours. Forty per cent of eyelid melanomas are, however, non-pigmented.

Clinical features

• Irregular borders

• Variegated pigmentation often with inflammation

• Occasional bleeding

Occasionally the eyelid may be secondarily involved by a conjunctival melanoma.

Classification:

• Lentigo maligna melanoma

• Superficial spreading melanoma

• Nodular melanoma.

Figure 6.7 Nodular malignant melanoma.

Superficial spreading melanoma appears typically as a brown lesion with shades of red, white and blue - it is initially flat but becomes nodular with increase in vertical growth. Nodular melanoma appears as a nodule or plaque, is dark brown or black in colour but can be amelanotic. It shows little radial growth, but extensive vertical growth (Figure 6.7).

Two classic histologic classifications are based on:

• Anatomic level of involvement (Clark)

• Tumour thickness (Breslow).

Tumour thickness is the most important predictor of prognosis. The average time to metastasis for cutaneous melanomas varies according to tumour thickness. The late onset of widespread disease is rare (cf. choroidal melanomas).

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