Purpose

Malignant melanoma (MM) of the eyelid is a rare, aggressive cancer (1% of cutaneous melanomas, 1% of malignant eyelid tumors (Tm)). The annual incidence is 0.4-0.6 per million.

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Methods

In April 2021, a 45-year-old patient came for an ophthalmological examination at the Clinic for Eye Diseases (Clinical Hospital Center Osijek). The examination revealed hyperpigmentation. Minor surgical procedure was recommended. A few months later, the full-thickness bleeding Tm of the lower eyelid with a crust, a temporally pigmented Tm of the upper eyelid, and irregular melanosis of the lower part of the bulbar conjunctiva were noticed. Pathohistological diagnosis after the biopsy was MM. Additionally, an orbital magnetic resonance imaging was performed – without any signs of propagation into the orbit. The patient did not decide on any form of treatment.

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Results

In April 2024 the patient came due to progression of the Tm – irregular, blood-filled, 2.5 cm in diameter, infiltrating the upper and lower eyelids. A cytological puncture of a lymph node on the right side of the neck was also performed – confirmed metastatic MM that is positive for the HMB-45 antibody.
After referring to an oncologist, the BRAF test was negative, and the stage of MM is 0 (Eastern Cooperative Oncology Group Performance Status, ECOG scale). Since May 2024, combined immunotherapy has been recommended – Ipilimumab (189 mg) with Nivolumab (63 mg), and then the use of Nivolumab alone was continued. A significant regression and improvement of the local status is observed after the applied therapy.

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Conclusion

Since eyelid carcinomas pose a serious threat of spreading to surrounding structures, timely diagnosis and proper treatment are necessary. A multidisciplinary approach and collaboration between ophthalmologists and oncologists is essential.

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Additional Authors

First name	Last name	Base Hospital / Institution
Marija	Olujić	Ophthalmology Polyclinic Dr. Balog, Ivana Gundulića 36 b, 31000 Osijek, Republic of Croatia; Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Republic of Croatia
Renata	Iveković	Clinic for Eye Diseases, Clinical Hospital Centre Sisters of Mercy Zagreb, Vinogradska cesta 29, 10000 Zagreb, Republic of Croatia
Dubravka	Biuk	Clinic for Eye Diseases, Clinical Hospital Centre Osijek, Europska avenija 14, 31000 Osijek, Republic of Croatia; Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Republic of Croatia
Zdenka	Kotromanović	Clinic for Oncology, Clinical Hospital Centre Osijek, Josipa Huttlera 4, 31000 Osijek, Republic of Croatia

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