Melanocytic Lesions of the Eyelid and Ocular Adnexa

This chapter covers pigmented lesions of the eyelid and ocular adnexa, including benign pigmented lesions, lesions with potential for transformation to melanoma, and invasive melanoma, including its various growth patterns. The section on "Eyelid Melanoma" includes information about histologic features, clinical characteristics, preferred biopsy techniques, and classification and staging. Local treatment options, including surgical resection, definition of appropriate surgical margins, and adjuvant postoperative radiation therapy or chemotherapy, are also outlined. The metastatic potential of eyelid melanoma and its association with conjunctival melanoma is emphasized. The chapter also includes a detailed discussion of sentinel node biopsy for ocular adnexal melanomas including indications, surgical technique, and experience to date. A new section has been added to cover the important discovery and availability of immune checkpoint inhibitors which have significantly improved the outlook for patients with metastatic ocular adnexal melanoma. A brief section on management of cutaneous melanoma metastatic to the orbit has been added to emphasize the availability of new treatment options for such patients through illustrative cases.