Eye
Uvea
TNM staging for uveal melanoma

Author: Nat Pernick, M.D. (see Authors page)

Revised: 16 April 2018, last major update February 2014

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: TNM staging uveal melanoma
Cite this page: Pernick, N. TNM staging for uveal melanoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/eyeuveatnmuvealmelanoma.html. Accessed October 15th, 2018.

Pathologic TNM staging of uveal melanoma, AJCC 7th edition
Definition / general
  • Apply to both clinical and pathologic staging
Primary tumor (T) - all uveal melanomas
  • TX: primary tumor cannot be assessed
  • T0: no evidence of primary tumor

    Iris:
    • T1: tumor limited to the iris
    • T1a: tumor limited to the iris, not more than 3 clock hours in size
    • T1b: tumor limited to the iris, more than 3 clock hours in size
    • T1c: tumor limited to the iris with secondary glaucoma
    • T2: tumor confluent with or extending into the ciliary body or choroid
    • T2a: tumor confluent with or extending into the ciliary body or choroid with secondary glaucoma
    • T3: tumor confluent with or extending into the ciliary body or choroid with scleral extension
    • T3a: tumor confluent with or extending into the ciliary body or choroid with scleral extension and secondary glaucoma
    • T4: tumor with extraocular extension
    • T4a: tumor with extraocular extension less than or equal to 5 mm in diameter
    • T4b: tumor with extraocular extension more than 5 mm in diameter

    Notes:
    • Iris melanomas originate from, and are predominantly located in, this region of the uvea
    • If less than half of the tumor volume is located within the iris, the tumor may have originated in the ciliary body, and consideration should be given to classifying it accordingly

  • Melanomalytic glaucoma: a type of secondary open angle glaucoma in melanoma patients with pigment laded macrophages that clog the trabecular meshwork

    Ciliary body and choroid (click here):
    • T1: tumor size category 1
    • T1a: tumor size category 1 without ciliary body involvement or extraocular extension
    • T1b: tumor size category 1 with ciliary body involvement
    • T1c: tumor size category 1 without ciliary body involvement but with extraocular extension less than or equal to 5 mm in diameter
    • T1d: tumor size category 1 with ciliary body involvement and extraocular extension less than or equal to 5 mm in diameter
    • T2: tumor size category 2
    • T2a: tumor size category 2 without ciliary body involvement or extraocular extension
    • T2b: tumor size category 2 with ciliary body involvement
    • T2c: tumor size category 2 without ciliary body involvement but with extraocular extension less than or equal to 5 mm in diameter
    • T2d: tumor size category 2 with ciliary body involvement and extraocular extension less than or equal to 5 mm in diameter
    • T3: tumor size category 3
    • T3a: tumor size category 3 without ciliary body involvement or extraocular extension
    • T3b: tumor size category 3 with ciliary body involvement
    • T3c: tumor size category 3 without ciliary body involvement but with
    • T3d: tumor size category 3 with ciliary body involvement and extraocular extension less than or equal to 5 mm in diameter extraocular extension less than or equal to 5 mm in diameter
    • T4: tumor size category 4
    • T4a: tumor size category 4 without ciliary body involvement or extraocular extension
    • T4b: tumor size category 4 with ciliary body involvement
    • T4c: tumor size category 4 without ciliary body involvement but with extraocular extension less than or equal to 5 mm in diameter
    • T4d: tumor size category 4 with ciliary body involvement and extraocular extension less than or equal to 5 mm in diameter
    • T4e: any tumor size category with extraocular extension more than 5 mm in diameter

  • When basal dimension and apical height do not fit this classification, the largest tumor diameter should be used for classification
  • In clinical practice, the tumor base may be estimated in optic disc diameters (dd) (average: 1 dd = 1.5 mm)
  • The height may be estimated in diopters (average: 3 diopters = 1 mm)
  • Techniques such as ultrasonography, visualization and photography are frequently used to provide more accurate measurements
Regional lymph nodes (N)
  • NX: regional lymph nodes cannot be assessed
  • N0: no regional lymph node metastasis
  • N1: regional lymph node metastasis
Distant metastasis (M)
  • M0: no distant metastasis
  • M1: distant metastasis
  • M1a: largest diameter of the largest metastasis is 3 cm or less
  • M1b: largest diameter of the largest metastasis is 3.1 to 8.0 cm
  • M1c: largest diameter of the largest metastasis is 8 cm or more
Stage grouping
I:T1aN0M0
IIA:T1b-dN0M0orT2aN0M0
IIB:T2bN0M0orT3aN0M0
IIIA:T2c-dN0M0orT3b-cN0M0orT4aN0M0
IIIB:T3dN0M0orT4b-cN0M0
IIIC:T4d-eN0M0
IV:any T,N1M0orany T,any N,M1a-c