Cutaneous tumors of the eyelid rarely spread via a perineural route.3 Pain is the most common symptom, accompanied by sensory loss in affected nerves, dysesthesia, and ophthalmoplegia.4 Sentinel lymph node biopsy is the best technique to predict local melanoma recurrence; however, in cases involving perineural spread, this procedure probably has much lower sensitivity. Our case is unusual in at least 2 respects. First, the initial sentinel lymph node biopsy results were negative. Second, the patient lacked the typical symptoms of perineural involvement. While this case is a rare example of malignant cutaneous melanoma both in its manifestation and clinical course, it underscores limitations of tumor staging using sentinel lymph node biopsy.