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Should this periocular lesion be biopsied?
JAAPA, 09/11/09

Monroe JR – A 94–year–old man is referred for evaluation of a lesion first noted several months earlier near the medial aspect of his left eye. Although the lesion was asymptomatic and had not caused any changes in vision, it had been growing, almost doubling in size over a 6–month period. As a young man, the patient had had a great deal of poorly tolerated sun exposure, and over the years, his medical history had included removal of several basal cell carcinomas...Melanoma is the likely diagnosis, of course, but purpura, seborrheic keratosis, and hemangioma must also be considered among the differential diagnoses. The patient's attitude about undergoing further treatment is understandable given his age. Without treatment, however, a melanoma at this site (assuming it is a melanoma) could, at the very least, cause serious local problems. Perhaps more basic to the patient's overall health, though, is the need to establish a firm diagnosis that could then serve to drive any future health decisions.