Eyelid
The most dangerous skin cancer around the eye — the ABCDE warning signs, and why early diagnosis and complete excision are critical.
Medically reviewed by Andrew M. Goldbaum, MDOculoplastic SurgeonLast updated June 2026
Andrew M. Goldbaum, MD
🏅 ASOPRS Fellow
Part of our complete guide to Eyelid Skin Tumors — this page covers eyelid melanoma in depth.
Cutaneous melanoma of the eyelid is rare, accounting for ~1% of eyelid malignancies, but carries the highest mortality of all periocular skin cancers. It arises from melanocytes in the epidermis and may occur de novo or within a pre-existing nevus. The most common subtype on the eyelid is lentigo maligna melanoma (arising in a slowly enlarging, irregularly pigmented macule in sun-damaged skin of older patients), followed by superficial spreading and nodular melanoma.
Diagnosis: The “ABCDE” criteria apply: Asymmetry, Border irregularity, Color variation (multiple shades of brown, black, red, or white), Diameter >6 mm (though melanoma can be smaller), and Evolution (change over time). Amelanotic melanoma lacks pigment and can mimic BCC or SCC — a high index of suspicion is required. Dermoscopy aids clinical assessment. Incisional or excisional biopsy with pathologic staging (Breslow depth, Clark level, mitotic rate, ulceration) is required before definitive surgery.
Treatment: Wide local excision with 5–10 mm margins (depending on Breslow depth) and sentinel lymph node biopsy for lesions >0.8 mm or with high-risk features. Lentigo maligna at the lid margin presents a reconstructive challenge because adequate margins may require full-thickness eyelid excision. Adjuvant systemic therapy (BRAF/MEK inhibitors for BRAF-mutant melanoma, anti-PD-1 immunotherapy) is used for high-risk or metastatic disease.
Schedule a consultation with Andrew M. Goldbaum, MD to learn if this procedure is right for you.
