Wide excision of eyelid tarsus with superficial lamellar lid margin tarsus excision for palpebral conjunctival melanoma

Conjunctival melanoma (CM) rarely occurs in the Chinese population. It is found more often in the non-bulbar area with worse prognosis compared with Caucasians. No consensus is reached regarding the standard surgical treatment of palpabral CM. We presented a 39-year-old Chinese female who developed CM at her right eye, involving superonasal palpebral conjunctiva, superonasal bulbar conjunctiva and medial caruncle. We excised the lesion including underlying Tenon capsule and the main part of underlying tarsus with a maximum clear margin of 4 mm, while sparing the tarsus of the eyelid margin. We applied a hemi-depth lamellar incision on the eyelid margin tarsus to preserve the contour of eyelid. Double freeze-thaw cryotherapy was applied to the excision margin, and the conjunctival deficit was closed by an amniotic membrane graft. We provided post-operation adjuvant chemotherapy with 0.02% mitomycin C three times daily for a schedule of three weeks on, one week off. Good cosmetic outcome was achieved with no recurrence in the following 36 months. Tarsus is important in lid function and for aesthetic appearance. To achieve wide-enough safety margin and intact eyelid contour, we presented a new simple approach with good cosmetic outcome and desirable disease control in palpebral CM surgery.