OBJECTIVE This study aimed to determine the prognostic factors for survival and disease-free interval for malignant melanoma of the eyelid skin. METHODS This was a retrospective, nonrandomized, clinical review. Twenty-four patients with eyelid skin melanoma were identified through a search of the tumor registry at M. D. Anderson Cancer Center. Patients were treated between 1953 and 1994. The follow-up ranged from 3 to 18 years (mean = 9.6 years). Primary treatment in all cases entailed wide local excision of the tumor. Patients in whom regional lymph node metastasis developed underwent parotidectomy or neck dissection, with or without adjuvant chemotherapy or external beam radiation. Descriptive statistics were used to characterize the patients. Survival analysis in terms of disease-free survival and recurrence-free survival was performed using age, sex, location of tumor (upper lid, lower lid, or both), histologic type of melanoma, Breslow thickness, and Clark's level as independent variables for survival. RESULTS Age, sex, location, and the histologic type of tumor were not significant prognostic indicators for survival in this cohort. Clark's level > or = IV by itself was a statistically significant predictor of decreased survival. In addition, tumors with either Clark's level > or = IV or Breslow thickness > or = 1.5 mm were associated with increased mortality. CONCLUSIONS Clark's level > or = IV or Breslow thickness > or = 1.5 mm are poor prognostic indicators for malignant melanomas of the eyelid skin. Clinicians should have a high level of suspicion for occult regional lymph node metastasis when treating patients with these tumor features.