Periocular pigmented nodular melanoma mimicking basal cell carcinoma in an elderly patient: Case report
Keywords:
basal cell carcinoma; biopsy; case reports; differential diagnosis; eyelid neoplasms; melanomaAbstract
Introduction: periocular melanoma is a rare malignant neoplasm that can mimic more common lesions, such as basal cell carcinoma, posing a diagnostic challenge. This case offers a significant lesson regarding the importance of differential diagnosis and histopathological confirmation for lesions that appear typical.
Objective: to present a case of a thick, pigmented nodular melanoma in the periocular region that was initially diagnosed as basal cell carcinoma.
Case presentation: a 75-year-old male presented with a 1.2 cm lesion on the lateral canthus of the right upper eyelid, clinically suggestive of basal cell carcinoma. During excision, dark intralesional pigmentation was observed, and an intraoperative frozen section biopsy confirmed melanoma. The margins were widened to 2 cm, and the defect was reconstructed using a free skin graft. Definitive histopathological analysis revealed pigmented nodular melanoma (Clark level IV; Breslow index 8 mm; pT4a) with clear margins.
Conclusions: this case highlights that periocular melanoma can mimic less aggressive cutaneous neoplasms. It underscores the need for a high index of suspicion—particularly regarding atypical pigmented lesions—and for meticulous histopathological assessment to ensure oncologically appropriate surgical management.
Downloads
References
1. National Cancer Institute. Cancer Stat Facts: Melanoma of the Skin. Surveillance, Epidemiology, and End Results Program, United States of America [Internet]. 2022 [citado 24 Ene 2026]. Disponible en: https://seer.cancer.gov/statfacts/html/melan.html
2. Swetter SM, Tsao H, Bichakjian CK, Curiel-Lewandrowski C, Elder DE, Gershenwald JE, et al. Guidelines of care for the management of primary cutane ous melanoma. J Am Acad Dermatol [Internet]. 2019 [citado 24 Ene 2026];80(1):208-50. Disponible en: https://www.sciencedirect.com/science/article/pii/S019096221832588X
3. Trotier DC, Huang L, Landingham SW, Burr AR, Ma VT. Review of recent advances in managing periocular skin malignancies. Front Oncol [Internet]. 2024 [citado 24 Ene 2026];14:1275930. Disponible en: https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2024.1275930/full
4. Gershenwald JE, Scolyer RA, Hess KR, Sondak VK, Long GV, Ross MI, et al. Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin [Internet]. 2017 [citado 24 Ene 2026];67(6):472-92. Disponible en: https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21409
5. Moran JM, Phelps PO. Periocular skin cancer: Diagnosis and management. Disease-a-Month [Internet]. 2020 [citado 24 Ene 2026];66(10):1016. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S0011502920301085
6. Asociación Médica Mundial. Declaración de Helsinki de la AMM. Principios éticos para las investigaciones médicas en seres humanos. Ratificada en la 75th WMA General Assembly, Helsinki, Finland, october 2024 [Internet]. Helsinki: 18ª Asamblea Mundial; 1964 [citado 24 Ene 2026]. Disponible en: https://www.wma.net/policies-post/wma-declaration-of-helsinki/
7. Eljilany I, Castellano E, Tarhini AA. Adjuvant Therapy for High-Risk Melanoma: An In-Depth Examination of the State of the Field. Cancers [Internet]. 2023 [citado 24 Ene 2026];15(16):4125. Disponible en: https://www.mdpi.com/2072-6694/15/16/4125
8. Garbe C, Amaral T, Peris K, Hauschild A, Arenberger P, Basset-Seguin N, et al. Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline. Part 1: Diagnostics: Update 2022. Eur J Cancer [Internet]. 2022 [citado 14 Ene 2026];170:236-55. Disponible en: https://www.sciencedirect.com/science/article/pii/S0959804922001526
9. Cazzato G, Resta L. Histopathologic diagnosis of melanoma: State of the Art. and perspective. Dermathology [Internet]. 2023 [citado 14 Ene 2026];2024(Número Especial). Disponible en: https://www.mdpi.com/journal/dermatopathology/special_issues/HDMM
10. Swetter SM, Johnson D, Albertini MR, Barker CA, Bateni S, Baumgartner J. NCCN Guidelines® Insights: Melanoma: Cutaneous, Version 2.2024: Featured Updates to the NCCN Guidelines. J National Comprehensive Cancer Network [Internet]. 2024 [citado 4 Feb 2026];22(5):290-298. Disponible en: https://jnccn.org/view/journals/jnccn/22/5/article-p290.xml
11. Cervatiuc M, Vladimirovich-Reshetov I, Vagovna-Saakyan S, Jonnazarov E, Viktorovna-Shklyaruk L, Ulugbekovich-Dzhapiev N, et al. Eyelid reconstruction methods: A 10-year review. Chinese J Plastic Reconstructive Surgery [Internet]. 2023 [citado 4 Feb 2026];5(4):205-11. Disponible en: https://www.sciencedirect.com/science/article/pii/S209669112300064X
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Yasiel Bernardo Verde Nieblas, Yilianny Yera Marín, Daniel Ramos-González Daniel Ramos-González
This work is licensed under a Creative Commons Attribution 4.0 International License.
Those authors who have publications with this journal accept the following terms of the License CC Attribution-NonCommercial 4.0 International (CC BY-NC 4.0):
You are free to:
- Share — copy and redistribute the material in any medium or format for any purpose, even commercially.
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
- Attribution — You must give appropriate credit , provide a link to the license, and indicate if changes were made . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
The journal is not responsible for the opinions and concepts expressed in the works, which are the exclusive responsibility of the authors. The Editor, with the assistance of the Editorial Committee, reserves the right to suggest or request advisable or necessary modifications. Original scientific works are accepted for publication, as are the results of research of interest that have not been published or sent to another journal for the same purpose.
The mention of trademarks of specific equipment, instruments or materials is for identification purposes, and there is no promotional commitment in relation to them, neither by the authors nor by the editor.
