Melanoma of the lower eyelid: what to know

Melanoma is a cancer of pigment-producing cells. On the eyelid, a changing dark spot, uneven colour, irregular edge, persistent crust, bleeding area or new thickening deserves examination. A lesion may be harmless, so appearance alone cannot confirm the diagnosis. A dermatologist, ophthalmologist or oculoplastic surgeon may inspect the eyelid, nearby skin and lymph nodes, then arrange a biopsy. The laboratory result identifies the cell type and features that guide staging.

Arrange an appointment promptly and bring photographs showing when the area changed, if available. Do not pick, burn or apply strong lightening products to the lesion. Assessment may lead to surgical excision with attention to clear edges and reconstruction of the eyelid. Further tests, including a sentinel lymph node biopsy, may be discussed when the tumour features make lymph-node assessment useful. Treatment can involve skin cancer surgery, tumour removal surgery or immunotherapy depending on stage and the specialist team’s findings.

Seek urgent medical advice for rapid enlargement, repeated bleeding, ulceration, new eyelid distortion, inability to close the eye, vision change or severe swelling. Sudden weakness, confusion, a seizure or a severe new headache requires emergency care because these are neurological warning signs, not signs to monitor at home.

Ask which biopsy is suitable, whether the lesion involves the eyelid margin, how much tissue may need removal, whether lymph-node assessment is relevant, and how reconstruction could affect blinking, tears and appearance. Ask which follow-up schedule is planned and which new changes should trigger a review.