Margin tumors should arouse the suspicion of a conjunctival neoplasm. The propensity of pigmented lesions to arise on the eyelid is related to the actinic exposure of the area. No contraindications to surgery are known. Because of the metastatic potential of melanoma, any suspicious lesions, warranting a metastatic workup, encompass the use of imaging studies. These demonstrate hyperpigmentation on the basal layer of the epidermis.
Junctional lesions show nests of nevus cells in the epidermis at the dermal-epidermal junction.
Compound nevus is when the nests of nevus cells are dropping off into the dermis, and, on intradermal lesions, the remaining epithelial nests migrate into the dermis. Compound nevi with spindle or epithelioid cells are present throughout the epidermis and dermis. Mitotic figures and nuclear atypia are present. Histologic differentiation from malignant melanoma may be difficult to make. Lesions contain balloon cells, with small pyknotic nuclei and granular or vacuolated cytoplasm.