Prognostic Significance of Histopathology of Primary Conjunctival Melanoma in Caucasians

Tuomaala, Seppo; Toivonen, Päivi; Al-Jamal, Rana’a T.; Kivelä, Tero

doi:10.1080/02713680701648019

Cited by 47 publications

(33 citation statements)

References 39 publications

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“…7 Poor prognostic histopathological features comprise high mitotic count, presence of epithelioid cells, diffuse intraepithelial disease, extravascular matrix pattern, lymphatic invasion/microvascular density, lymphocytic/macrophage infiltration, and surface ulceration. 4,27,43 There is compelling circumstantial evidence correlating local-tumour recurrence with metastasis. 8,27,39,41 In 45-60% of cases, the first site for metastasis is the regional lymph nodes, developing after a median of 2.3 years.…”

Section: Prognosismentioning

confidence: 99%

Conjunctival melanoma and melanocytic intra-epithelial neoplasia

Kenawy

Lake

Coupland

et al. 2012

Eye

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Section: Prognosismentioning

confidence: 99%

Conjunctival melanoma and melanocytic intra-epithelial neoplasia

Kenawy

Lake

Coupland

et al. 2012

Eye

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“…51 Histopathological and genetic prognostication Although many histopathological featuers of conjunctival melanoma have been associated with prognosis in retrospective studies, none has been consistently and independently verified after taking into account the location and the size of the tumour. 52 The current pTNM system 9 relies on tumour thickness and invasion of substantia propria, setting cut-points at 0.5 and 1.5 mm (Table 4). Genetic prognostic markers are not available.…”

Section: Prognosis Of the Primary Tumourmentioning

confidence: 99%

Prognostication in eye cancer: the latest tumor, node, metastasis classification and beyond

Kivelä

Kujala

2012

Eye

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The tumour, node, metastasis (TNM) classification is a universal cancer staging system, which has been used for five decades. The current seventh edition became effective in 2010 and covers six ophthalmic sites: eyelids, conjunctiva, uvea, retina, orbit, and lacrimal gland; and five cancer types: carcinoma, sarcoma, melanoma, retinoblastoma, and lymphoma. The TNM categories are based on the anatomic extent of the primary tumour (T), regional lymph node metastases (N), and systemic metastases (M). The T categories of ophthalmic cancers are based on the size of the primary tumour and any invasion of periocular structures. The anatomic category is used to determine the TNM stage that correlates with survival. Such staging is currently implemented only for carcinoma of the eyelid and melanoma of the uvea. The classification of ciliary body and choroidal melanoma is the only one based on clinical evidence so far: a database of 7369 patients analysed by the European Ophthalmic Oncology Group. It spans a prognosis from 96% 5-year survival for stage I to 97% 5-year mortality for stage IV. The most accurate criterion for prognostication in uveal melanoma is, however, analysis of chromosomal alterations and gene expression. When such data are available, the TNM stage may be used for further stratification. Prognosis in retinoblastoma is frequently assigned by using an international classification, which predicts conservation of the eye and vision, and an international staging separate from the TNM system, which predicts survival. The TNM cancer staging manual is a useful tool for all ophthalmologists managing eye cancer. Keywords: conjunctival malignancies; eyelid malignancies; orbital malignances; retinoblastoma; uveal melanomaThe tumour, node, metastasis (TNM) classification is a cancer staging system, which has been in worldwide use across all medical specialties for five decades. 1 It emerged in 1968 when the International Union Against Cancer published the first edition of its classification based on the anatomic extent of the tumour after testing a set of draft classifications for 23 cancer sites. None of these sites related to the eye.Indeed, eye cancer is a latecomer in the TNM classification, appearing for the first time in the fourth and fifth editions. 2 The first ophthalmic section covered six sites and five cancer types-carcinoma and melanoma of the eyelid and conjunctiva, melanoma of the uvea, retinoblastoma, sarcoma of the orbit, and carcinoma of the lacrimal gland-but these classifications were untested and were rarely used outside cancer registries.The ophthalmic section was revised for the sixth edition of TNM in 2002. 3 This edition was based on the published literature, but the classifications were not tested against clinical data. The revision received publicity 4 but did not make a breakthrough. Meanwhile, data were collected of other cancers to improve staging. For the updated TNM classification of cutaneous melanoma, data from over 20 000

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“…Local recurrences and larger basal diameter are also predictive of decreased survival [2]. Controlling for clinical variables, other histopathologic features are not consistently associated with mortality [26,27]. The presence of isolated, distant metastases is associated with a mean survival of 0.42 years versus 8.1 years for purely nodal disease [9].…”

Section: Mortalitymentioning

confidence: 99%

Conjunctival melanoma: pitfalls and dilemmas in management

Shildkrot

Wilson

2010

Current Opinion in Ophthalmology

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The management of conjunctival surface melanomas is complicated by local recurrence and metastatic disease, particularly for lesions greater than 2 mm in thickness and arising from nonbulbar conjunctiva. Early complete excision with appropriate adjuvant cryotherapy and topical chemotherapy may be curative in some patients. Conjunctival anatomy and high recurrence rate with resultant metastatic spread undermines the utility of sentinel lymph node biopsy in this condition. Further research and innovation for detection of systemic micrometastases and treatment of metastatic disease are needed.

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Prognostic Significance of Histopathology of Primary Conjunctival Melanoma in Caucasians

Abstract: Histopathological factors are not consistently associated with survival in CM. Tumor location, thickness, and recurrence are predictors of mortality from CM.

Cited by 47 publications

References 39 publications

Conjunctival melanoma and melanocytic intra-epithelial neoplasia

Conjunctival melanoma and melanocytic intra-epithelial neoplasia

Prognostication in eye cancer: the latest tumor, node, metastasis classification and beyond

Conjunctival melanoma: pitfalls and dilemmas in management

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