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Ophthalmic Tumours

Malignant Melanoma of Conjunctiva (ICD‐O‐3 C69.0) Rules for Classification The classification applies only to conjunctival malignant melanoma.

There should be histological confirmation of the disease.

The following are the procedures for assessing T, N, and M categories: T categories Physical examination N categories Physical examination M categories Physical examination and imaging

Regional Lymph Nodes The regional lymph nodes are the preauricular, submandibular, and cervical lymph nodes.

TNM Clinical Classification T – Primary Tumour TX T0 Tis

Primary tumour cannot be assessed No evidence of primary tumour Melanoma confined to the conjunctival epithelium (in situ)a

T1 Melanoma of the bulbar conjunctiva T1a Tumour involves less than or equal to one quadrantb T1b Tumour involves more than one but less than or equal to two quadrants T1c Tumour involves more than two but less than or equal to three quadrants T1d Tumour involves more than three quadrants T2 Malignant conjunctival melanoma of the non‐bulbar conjunctiva involving palpebral, forniceal, and/or caruncular conjunctiva T2a Non‐caruncular tumour involves less than or equal to one quadrant T2b Non‐caruncular tumour involves more than one quadrant T2c Caruncular tumour involves less than or equal to one quadrant of conjunctiva T2d Caruncular tumour involves more than one quadrant of conjunctiva

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T3 Tumour with local invasion into: T3a Globe T3b Eyelid T3c Orbit T3d Paranasal sinus, nasolacrimal duct, and/or lacrimal gland T4 Tumour invades central nervous system Notes a Melanoma in situ (includes the term primary acquired melanosis) with atypia replacing greater than 75% of the normal epithelial thickness with cytological ­features of epithelial cells, including abundant cytoplasm, vesicular nuclei, or prominent nucleoli, and/or p ­ resence of intraepithelial nest of atypical cells. b Quadrants are defined by clock hour, starting at the limbus (e.g., 6, 9, 12, 3) extending from the central cornea, to and beyond the eyelid margins. This will bisect the caruncle.

NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Regional lymph node metastasis

M – Distant Metastasis M0 No distant metastasis M1 Distant metastasis

pTNM Pathological Classification pT – Primary Tumour pTX pT0 pTis

Primary tumour cannot be assessed No evidence of primary tumour Melanoma confined to the conjunctival epithelium (in situ)*

pT1 Melanoma of the bulbar conjunctiva pT1a Tumour 2.0 mm or less in thickness with invasion of the ­substantia propria pT1b Tumour more than 2.0 mm in thickness with invasion of the substantia propria

Ophthalmic

N – Regional Lymph Nodes

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pT2 Melanoma of the palpebral, forniceal or caruncular conjunctiva pT2a Tumour 2.0 mm or less in thickness with invasion of the ­substantia propria pT2b Tumour more than 2.0 mm in thickness with invasion of the substantia propria pT3 Melanoma invades the eye, eyelid, nasolacrimal system or orbit pT3a Invades the globe pT3b Invade the eyelid pT3c Invades the orbit pT3d Invades the paranasal sinus and/or nasolacrimal duct or ­lacrimal sac pT4 Melanoma invades central nervous system Note * pTis Melanoma in situ (includes the term primary acquired melanosis) with atypia replacing greater than 75 % of the normal epithelial thickness, with cytological features of epithelioid cells, including abundant cytoplasm, vesicular nuclei or prominent nucleoli, and/or presence of intraepithelial nests of atypical cells.

pN – Regional Lymph Nodes The pN categories correspond to the N categories.

pM – Distant Metastasis For pM categories see page 8.

G – Histopathological Grading Histological grade represents the origin of the primary tumour.

GX Origin cannot be assessed G0 Primary acquired melanosis without cellular atypia G1 Conjunctival nevus G2 Primary acquired melanosis with cellular atypia (epithelial disease only) G3 Primary acquired melanosis with epithelial cellular atypia and i­ nvasive melanoma G4 De novo malignant melanoma

Stage No stage is at present recommended.