Eye
General
Staging-conjunctiva melanoma


Topic Completed: 26 January 2021

Minor changes: 26 January 2021

Copyright: 2004-2021, PathologyOutlines.com, Inc.

PubMed Search: TNM staging for melanoma of conjunctiva pathology


Martin Hyrcza, M.D., Ph.D., M.Sc.
Page views in 2020: 593
Page views in 2021 to date: 141
Cite this page: Hyrcza M. Staging-conjunctiva melanoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/eyeconjTNMmelanoma.html. Accessed March 3rd, 2021.
Definition / general
  • Based on AJCC 8th edition staging system
  • Used for melanomas arising from bulbar and palpebral conjunctiva, the caruncle and the fornices
  • Not applicable to primary eyelid skin melanomas
  • Not applicable to uveal melanomas with secondary involvement of conjunctiva
Essential features
  • AJCC 7th edition staging was sunset on December 31, 2017; as of January 1, 2018, use of the 8th edition is mandatory
Terminology
  • Bulbar conjunctiva is the mucosal epithelium lining the surface of the eye
  • Palpebral conjunctiva is the mucosal epithelium lining the inner surface of the eyelid
  • Caruncle is the fleshy protuberance in the inner corner (canthus) of the eye
  • Fornix (plural fornices) is the loose fold of conjunctiva at the reflection from the bulbar to the palpebral conjunctiva, present superiorly and inferiorly
ICD coding
  • ICD-10: C69.0 - Conjunctiva
Primary tumor (pT)
  • pTX: primary tumor cannot be assessed
  • pT0: no evidence of primary tumor
  • pT1: tumor of the bulbar conjunctiva
    • pT1a: tumor of the bulbar conjunctiva with ≤ 2 mm of invasion of substantia propria
    • pT1b: tumor of the bulbar conjunctiva with > 2 mm of invasion of substantia propria
  • pT2: tumor of nonbulbar conjunctiva (i.e. palpebral, forniceal or caruncle)
    • pT2a: tumor of the nonbulbar conjunctiva with ≤ 2 mm of invasion of substantia propria
    • pT2b: tumor of the nonbulbar conjunctiva with > 2 mm of invasion of substantia propria
  • pT3: tumor of any size with local invasion
    • pT3a: invasion of the globe
    • pT3b: invasion of the eyelid
    • pT3c: invasion of the orbit
    • pT3d: invasion of the nasolacrimal duct, lacrimal sac or paranasal sinuses
  • pT4: tumor of any size with invasion of the central nervous system
Regional lymph nodes (pN)
  • pNX: regional lymph nodes cannot be assessed
  • pN0: no regional lymph node metastasis
  • pN1: regional lymph node metastasis

Notes:
  • Regional lymph nodes are the preauricular, parotid, postauricular, submandibular and cervical
Distant metastasis (pM)
  • pM0: no distant metastasis
  • pM1: distant metastasis
Prefixes
  • y: preoperative radiotherapy or chemotherapy
  • r: recurrent tumor stage
AJCC prognostic stage groups
  • There are currently no proposed prognostic groups
Registry data collection variables
  • Tumor thickness: depth of invasion measure in millimeters into substantia propria from the surface of the conjunctiva
  • Presence or absence of epithelioid cytology
  • Mitotic count: number of mitoses per square millimeter
  • Margin status
  • Presence or absence of
    • Ulceration
    • Epithelioid cytology
    • Growth regression
    • Lymphatic invasion
    • Angioinvasion
    • Perineural invasion
    • Conjunctival melanoma in situ
    • Conjunctival nevus
    • Microsatellites / in transit metastases
Histologic grade (G)
  • Grading is not performed
Histopathologic type
  • Spindle cell
  • Epithelioid
  • Anaplastic
Board review style question #1
The AJCC 8th edition staging for the conjunctiva should be used for which of these tumors

  1. Caruncle melanoma
  2. Eyelid melanoma
  3. Uveal melanomas with secondary involvement of conjunctiva
  4. Metastatic melanoma
Board review style answer #1
A. Caruncle melanoma

This staging should be used for melanomas arising from bulbar and palpebral conjunctiva, the caruncle and the fornices but not for primary eyelid skin melanomas or uveal melanomas with secondary involvement of conjunctiva. Although not specifically described in this topic, primary staging systems in general should not be used for metastases.

Comment Here

Reference: Staging-conjunctiva melanoma
Back to top
Image 01 Image 02