Mustardé Flap for Eyelid and Conjunctival Melanoma

Purpose: To report a case of wide excision followed by eyelid reconstruction using a Mustardé flap in a patient with malignant melanoma involving the lower eyelid and conjunctiva.Case summary: An 81-year-old female presented with a black mass involving the entire right lower eyelid, palpebral conjunctiva, inferior and superonasal bulbar conjunctiva, and caruncle. Best-corrected visual acuity was 1.0 in both eyes. Slit-lamp and fundus examinations revealed no intraocular involvement, and biopsy confirmed the diagnosis of malignant melanoma. The patient declined exenteration and expressed a strong desire to preserve the globe. Full-thickness excision of the entire lower eyelid was performed. Posterior lamellar reconstruction was carried out using an auricular cartilage graft combined with a free oral mucosal graft. Anterior lamellar reconstruction was achieved using a Mustardé flap. The eyelid contour was well-maintained for 17 months postoperatively, with no evidence of local recurrence or distant metastasis, and the patient reported satisfactory cosmetic outcomes. No complications related to the grafts or flap were observed.Conclusions: In cases of malignant melanoma confined to the eyelid and conjunctiva without intraocular invasion in patients who desire globe-sparing surgery, extensive resection of the entire eyelid followed by reconstruction with auricular cartilage, oral mucosa, and a Mustardé flap may yield favorable functional and cosmetic outcomes.