The reported incidence of choroidal melanoma is low among the general population and is especially low among blacks. Choroidal melanoma is seen most commonly in whites in the sixth to seventh decades. The tumor is complicated by orbital invasion in only a small percentage of cases. This report describes the case of a 38-year-old black man diagnosed with a choroidal melanoma of the right eye. The tumor exhibited extensive orbital invasion. Primary or metastatic disease elsewhere in the body was ruled out, and the patient underwent an eyelid-sparing orbital exenteration. Histopathologic examination of the orbital specimen confirmed the diagnosis of spindle cell-type choroidal melanoma. Orbital invasion by a primary choroidal melanoma in a black person under the age of 40 is highly unusual. To our knowledge, this represents the youngest reported case of choroidal melanoma with extrascleral extension in a black patient. Ophthalmologists should consider the possibility of this potentially deadly tumor, even in young, black patients.

A patient who had been taking an oral L-arginine-based body-building supplement developed bilateral diffuse subconjunctival hemorrhages, circumcorneal dilated vessels, and peripheral corneal infiltrates after bilateral laser in situ keratomileusis. There is limited information regarding the efficacy, safety, and constituents of nutritional supplements because the U.S. Food and Drug Administration regulates them differently than prescription medications, and they do not require approval prior to marketing. These products may result in adverse effects as evidenced by the subconjunctival hemorrhages (an exaggerated vasodilator and antithrombotic effect of nitric oxide formed from arginine) and peripheral corneal infiltrates in this case. The case highlights the importance of eliciting a history of nutritional supplement and/or herbal medication use, especially in patients scheduled to have surgery.

Mucoepidermoid carcinoma (MEC) is most commonly found to affect the salivary glands and rarely affects other organ systems. In this report, we present an especially rare case of cutaneous MEC affecting the eyelid. A 72-years-old female patient presented with a painless, cyst-like, progressively enlarging lesion of the left upper eyelid. Biopsy revealed characteristic features of MEC, including a mixture of mucus-secreting cells and epidermoid cells. The 3 mm MEC lesion was excised by Mohs micrographic surgery, leaving a 0.8 × 1.1 cm eyelid defect that was repaired by oculoplastic reconstruction. To date, the patient has been in remission for 4 years with good functional and aesthetic outcomes. This case represents the longest reported remission among only 9 previously reported cases of cutaneous MEC of the eyelid and highlights the therapeutic and aesthetic efficacy of Mohs micrographic surgery. We also offer a literature review of the 9 previously reported cases of eyelid MEC and a discussion of patient presentation, treatment comparisons, remission success, and key points in the management of MEC of the eyelid.