Eye

• All melanomas arising from the bulbar and palpebral conjunctiva and the caruncle are covered by this staging system
• Primary eyelid melanomas and secondary involvement of the conjunctiva by extraocular uveal melanoma are not covered within this chapter; cutaneous melanomas, including those primary to the eyelid, are staged according to the AJCC melanoma of the skin staging system and uveal melanomas that extend to the conjunctiva are staged according to the AJCC uveal melanoma staging system

• AJCC 7th edition staging was sunset on December 31, 2017; as of January 1, 2018, use of the 8th edition is mandatory

• Clinical tumor (cT)
  • cTX: primary tumor cannot be assessed
  • cT0: no evidence of primary tumor
  • cT1: tumor of the bulbar conjunctiva
    • cT1a: < 1 quadrant
    • cT1b: ≥ 1 to < 2 quadrants
    • cT1c: ≥ 2 to < 3 quadrants
    • cT1d: ≥ 3 quadrants
  • cT2: tumor of the nonbulbar (forniceal, palpebral, tarsal) conjunctiva and tumor involving the caruncle
    • cT2a: noncaruncular and ≤ 1 quadrant of the nonbulbar conjunctiva involved
    • cT2b: noncaruncular and > 1 quadrant of the nonbulbar conjunctiva involved
    • cT2c: caruncular and ≤ 1 quadrant of the nonbulbar conjunctiva involved
    • cT2d: caruncular and > 1 quadrant of the nonbulbar conjunctiva involved
  • cT3: tumor of any size with local invasion
    • cT3a: globe
    • cT3b: eyelid
    • cT3c: orbit
    • cT3d: nasolacrimal duct or lacrimal sac or paranasal sinuses
  • cT4: tumor of any size with invasion of the central nervous system
• Pathological tumor (pT)
  • pTX: primary tumor cannot be assessed
  • pT0: no evidence of primary tumor
  • pTis: melanoma confined to the conjunctival epithelium
  • pT1: tumor of the bulbar conjunctiva
    • pT1a: tumor of the bulbar conjunctiva with invasion of the substantia propria, ≤ 2.0 mm in thickness
    • pT1b: tumor of the bulbar conjunctiva with invasion of the substantia propria, > 2.0 mm in thickness
  • pT2: tumor of the nonbulbar (forniceal, palpebral, tarsal) conjunctiva and tumor involving the caruncle
    • pT2a: tumor of the nonbulbar conjunctiva with invasion of the substantia propria, ≤ 2.0 mm in thickness
    • pT2b: tumor of the nonbulbar conjunctiva with invasion of the substantia propria, > 2.0 mm in thickness
  • pT3: tumor of any size with local invasion
    • pT3a: globe
    • pT3b: eyelid
    • pT3c: orbit
    • pT3d: nasolacrimal duct or lacrimal sac or paranasal sinuses
  • pT4: tumor of any size with invasion of the central nervous system

• pNX: regional lymph nodes cannot be assessed
• pN0: no regional lymph node metastasis
• pN1: regional lymph node metastasis

Notes:

• Regional lymph nodes include the preauricular (parotid), postauricular, submandibular and cervical lymph nodes

• pM0: no distant metastasis
• pM1: distant metastasis

Notes:

• The c designation indicates clinical signs or symptoms, while the p designation indicates that at least 1 distant metastatic site has been histologically confirmed
• Most common metastatic sites are the lungs, liver, brain and bones

• y: preoperative radiotherapy or chemotherapy
• r: recurrent tumor stage

Contributed by Katharina Janda, M.D. and J. Stephen Nix, M.D.

A palpebral melanoma invades the substantia propria and measures < 2 mm in thickness (see image above). What is the appropriate pT stage?

1. pTis
2. pT1a
3. pT2a
4. pT3a
5. pT4

C. pT2a. The melanoma arises in nonbulbar (palpebral) conjunctiva and invades the substantia propria but to a thickness of < 2 mm, corresponding to a pT2a classification. Answer A is incorrect because pTis is used for in situ disease. Answer B is incorrect because pT1 designations are used for melanomas of the bulbar conjunctiva that do not qualify for higher stages. Answer D is incorrect because pT3a refers to conjunctival melanomas of any size that invade the globe. Answer E is incorrect because pT4 refers to conjunctival melanomas of any size that invade the central nervous system.

Comment Here

Reference: Staging-conjunctiva melanoma

Which of the following lesions should be staged using the conjunctival melanoma staging protocol (AJCC 8th edition)?

1. Melanoma arising from the nose (skin) and extending to the conjunctiva
2. Melanoma arising in the anterior, external portion of the eyeball
3. Melanoma arising in the uvea and extending to the eyeball surface
4. Sebaceous carcinoma of the conjunctiva
5. Squamous cell carcinoma of the conjunctiva

B. Melanoma arising in the anterior, external portion of the eyeball. The anterior portion of the eyeball is covered by the bulbar conjunctiva; therefore, the neoplasm would be staged using the conjunctival melanoma staging protocol (AJCC 8th edition). Answer C is incorrect because a melanoma arising from the uvea would be staged according to the uveal melanoma staging protocol. Answer A is incorrect because a cutaneous melanoma would be staged according to the melanoma of the skin protocol. Answers D and E are incorrect because sebaceous carcinoma and squamous cell carcinoma of the conjunctiva would be staged using the conjunctiva carcinoma staging protocol.

Comment Here

Reference: Staging-conjunctiva melanoma