This is a pigmented mass largely involving the epithelial surfaces as well as deeper tissues. A malignant melanoma is the likeliest diagnosis. Management is likely to involve extensive tissue loss, and possibly loss of the eye and orbital tissues. Evaluation of its extent could include high resolution imaging as well as sentinel lymph node biopsy.

Management is thus best conducted from a multispecialty facility, such as the Melanoma Clinic at the Alfred Hospital or the Peter MacCallum Centre’s Head and Neck Unit. The most useful first step is to expedite the referral, and to confirm that the patient is given a correct appointment. Taking a biopsy or investigating systemically is more likely to cause unnecessary delay, and these are best decided upon and done by the team which will continue the management, and their own pathology and imaging services. A referral to any of the specialists listed above would result in a successful transfer to such a unit as well. However it is arranged, any referral must be confirmed to be within about 10 days or less. It would not be safe to allow the patient to make their own booking.