• Written By: Matthew W. Wilson, MD, FACS
    Ocular Pathology/Oncology

    This retrospective review of a relatively large cohort of conjunctival melanoma patients found that the current American Joint Committee on Cancer (AJCC) classification scheme is indeed useful in clinical practice for predicting patient prognosis. More specifically, the authors found that melanoma classified as T2 or T3, compared with T1, showed significantly higher rates of local recurrence, regional lymph node metastasis, distant metastasis and death.

    They conducted a chart review of 343 patients with conjunctival melanoma seen at the Oncology Service of Wills Eye Institute in Philadelphia between April 1, 1970, and July 1, 2003.

    Patients were staged according to the recently published AJCC seventh edition classification as T1 (57 percent), T2 (32 percent), T3 (11 percent) or T4 (0 percent). Mean tumor basal diameter increased with staging. More than 70 percent of tumors arose from primary acquired melanosis with atypia, while 12 to 21 percent, depending upon staging, arose de novo, and fewer than 10 percent arose from pre-existing nevi.

    At five years, Kaplan-Meier estimates of local recurrence or new tumor formation, nodal metastases, distant metastases and melanoma deaths were significantly greater with advanced tumor staging. Multivariate analysis found that melanoma arising de novo, T2 stage and T3 stage were predictive of regional lymph node metastases, melanoma-related distant metastases and melanoma-related death.