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  • Tumor Staging: Conjunctival Melanoma Outcomes

    By Lynda Seminara
    Selected by Russell N. Van Gelder, MD, PhD
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    Journal Highlights

    Ophthalmology, July 2022

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    Although conjunctival melanoma (CM) is a rare cancer, it has grown in prev­alence and has the potential to metas­tasize. Jia et al. studied the predictive value of the tumor staging system described in the AJCC Cancer Staging Manual (8th edition) and explored histologic features linked to outcomes and metastasis patterns in patients with CM. In their review, the staging system was effective prognostically. Most cases of CM presented in an advanced stage, and the rate of distant metastases was high.

    The retrospective cohort included 83 patients with CM who were treated in China during the last two decades. The authors documented clinical and histologic findings for each patient and used Kaplan-Meier survival curves and Cox proportional-hazards models to analyze risk factors. Main outcome measures were disease-specific survival period, metastatic pattern and site, and time to nodal/distant metastasis.

    At presentation, the tumors of five patients (6%) were staged as cT1 (clinical tumor 1), those of 34 patients (41%) were classified as cT2, and those of 44 patients (53%) were graded as cT3. Four patients (5%) had nodal metasta­sis at presentation, and none had dis­tant metastasis. During the follow-up period, nodal metastasis was observed in 12 patients (14%), distant metastasis occurred in 29 (35%), and there were 26 (31%) disease-related deaths. Com­mon sites of metastases were the brain, liver, and lungs. Patients with brain involvement had a poor prognosis, and their median survival time was only five months.

    A high cT category carried greater risk of distant metastasis (p < .001) and disease-specific death (p = .002).A separate analysis that included primary and recurrent tumors showed that metastatic risk was highest for cT3 tumors. Ulceration, thicker tumors, and regression correlated with distant metastasis. Among the 29 patients who experienced distant metastasis, 11 (38%) had nodal metastasis before distant metastasis, and 18 (62%) had distant metastasis without previously known nodal metastasis. Grade cT3 tumors generally followed the latter pattern. Previously unreported mu­tations were detected in the tumor suppressor genes FAT4 and SYK.

    These findings indicate that patients who present with a cT3 tumor are more likely than those with lower-grade tumors to develop distant metastasis without previous nodal metastasis. The authors emphasized that histologic features such as thickness and ulceration may help to determine prognosis and optimal treatment. The results of this study will allow physicians to provide more accurate prognostic information for patients with CM.

    The original article can be found here.