• Cornea/External Disease, Ocular Pathology/Oncology

    This case series assesses the accuracy of the 8th of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual for estimating mortality rates of conjunctival melanoma.

    Study design

    This international, multicenter, registry-based case series pooled data from 10 ophthalmic oncology centers from 9 countries on 4 continents. The authors identified 288 patients diagnosed with conjunctival melanoma from 2001 through 2013.


    The analysis revealed that 75.7% of clinical primary tumors (cT) were staged as cT1, 11.8% as cT2, 5.2% as cT3 and 7.3% as cTx; there were no cT4 tumors. Metastasis at presentation was seen in 5 patients (1.7%). Metastasis during follow-up developed in 24 patients (8.5%) after a median of 4.3 years. Twenty-nine died (melanoma-related mortality, 10.1%) at a median of 5.3 years.

    At 5 years, the cumulative mortality rate was 25% among patients with cT1 tumors, 28.6% for those with cT2 tumors and 31.6% for those with cT3 tumors. Patients with cT2 and cT3 tumors had a significantly higher cumulative mortality rate compared with those presenting with cT1 tumors (P<0.001). Ulcerated melanomas had over 7-fold higher risk of mortality (HR 7.58; P=0.04).


    This study was limited by its retrospective design and lack of cT4 tumors. There was no data on ethnic/racial background even though data were derived from 4 continents.

    Clinical significance

    This shows the proof of concept that conjunctival melanoma staging with 8th Edition of AJCC Cancer Staging Manual can be used with a diverse group to estimate mortality from metastatic conjunctival melanoma. This paper proves that international, multicenter, cancer registry studies can be successfully performed to study ocular cancer.