Superficial spread melanoma is typified by atypical melanocytes that occur in nests throughout all levels of epidermis. In nodular melanoma, dermal invasion is always present, and it exhibits large anaplastic epithelioid cells. The benign pigmented lesions of the eyelids do not require any medical therapy. However, any benign lesion that affects vision should be excised with primary reconstruction. In the first 10 years of life, this can lead to amblyopia and permanent reduction of vision if not treated in a timely fashion.
Malignant lesions require surgical excision for treatment.
The procedure of choice for treatment of cutaneous malignant melanoma of the eyelid is wide surgical excision with 1 cm of skin margins confirmed by histology. Surgical excision always should be performed with attention placed toward obtaining clean surgical margins. Mohs surgery is a new technique and is not offered in many rural areas. Although both modalities achieve the same endpoint, it has been postulated that Mohs surgery provides a more definitive result. This does not mean that frozen section analysis is in any way inadequate or inferior, as frozen section analysis does yield excellent results.