A recent study evaluated the side effects of conjunctival melanoma based on the 8th edition of the American Joint Committee’s cancer classification and found increased risk of vision loss and melanoma-related complications over time.

The retrospective, interventional case series included 425 patients with conjunctival melanoma, classified as T1 (63%), T2 (18%) and T3 (20%). The researchers found that primary acquired melanosis was more common in T2 and conjunctival nevus was more common in T1 (Table 1).

At the five-year follow-up, the investigators noted that more severe stages of melanoma were associated with a greater chance of local recurrence or new tumor formation, exenteration, locoregional lymph node metastasis, systemic metastasis and death. After 10 years of follow-up, they observed reduced visual acuity of greater than three lines across T categories (32% vs. 42% vs. 63%) and increased melanoma-related complications (Table 2).

The study authors concluded that all conjunctival melanoma patients experienced more severe side effects of the condition as the follow-up period progressed.

Table 1. Cancer Risk by T Category

  Primary acquired melanosisConjunctival nevus 
T1 81%20% 
T2 96%9% 
 T3 81%11% 

Table 2. Melanoma-related Complications by Follow-up

  Local recurrence or new tumor formationExenteration Lymph node metastasisSystemic metastasisDeath
  5 yrs10 yrs 5 yrs 10 yrs 5 yrs 10 yrs 5 yrs 10 yrs 5 yrs 10 yrs 
 T1 30%47% 3% 4% 2% 3% 9% 13% 4% 8% 
T243% 70% 9% 24% 7% 13% 25% 45% 12% 22% 
T349% 74% 28% 46% 12% 25% 23% 40% 18% 37% 

Shields C, Yaghy A, Dalvin LA, et al. Conjunctival melanoma: outcomes based on the American Joint Committee on Cancer Clinical Classification (8th Edition) of 425 patients at a single ocular oncology center. Asia Pac J Ophthalmol (Phila). December 9, 2020. [Epub ahead of print].