Uveal melanoma staging

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

According to the American Joint Committee on Cancer, there are four stages of uveal melanoma based on the tumor size, spread to nearby lymph nodes, and metastasis. Each stage is assigned a number 0 through 4 that indicate increasing severity and letters T, N, and M that designate the tumor size, spread to nearby lymph nodes, and metastasis respectively.

Staging

The most common staging system used for melanoma of the uveal tract was developed by the American Joint Committee on Cancer (AJCC). The TNM system is based on three key pieces of information:

• T describes the size of the primary tumor and/or whether it has invaded nearby structures
• N describes whether the cancer has spread to nearby (regional) lymph nodes
• M indicates whether the cancer has metastasized (spread) to other parts of the body (The most common site of eye melanoma spread is the liver)
• Numbers or letters appear after T, N and M to provide more details about each of these factors:
  • The numbers 0 through 4 indicate increasing severity
  • The letter X means "cannot be assessed" because the information is not available.
  • The N and M categories are the same for all uveal melanomas (iris, ciliary body or choroid).
  • The T categories, however, are different for these locations.

T categories for iris melanoma

Stage	Tumor location
TX	The main (primary) tumor cannot be assessed; information not known
T0	No evidence of a primary tumor
T1	Tumor is only in the iris
T1a	The tumor is only in the iris and touches 1/4 or less of the iris
T1b	The tumor is only in the iris and touches more than 1/4 of the iris
T1c	The tumor is only in the iris and is causing an increase in the eye pressure (glaucoma)
T2	Tumor has grown into the ciliary body or choroid (or both)
T2a	Tumor has grown into the ciliary body and/or choroid and is causing glaucoma
T3	Tumor has grown into the ciliary body and/or choroid and into the sclera
T3a	Tumor has grown into the ciliary body and/or choroid and into the sclera and is causing glaucoma
T4	Tumor extends outside the eyeball
T4a	The part of the tumor that is outside the eyeball is 5 millimeters (about 1/5 of an inch) or less across in size
T4b	The part of the tumor that is outside the eyeball is greater than 5 millimeters (about 1/5 of an inch) in size

T categories for ciliary body and choroidal melanoma

Stage	Tumor location
TX	The main (primary) tumor cannot be assessed; information not known
T0	No evidence of a primary tumor
T1	Tumor size is either: No more than 3millimeters deep and no more than 12 millimeters across, OR From 3.1 to 6 millimeters deep and no more than 9 millimeters across
T1a	The tumor is T1 in size and is not growing into the ciliary body or growing outside the eyeball
T1b	The tumor is T1 in size and is growing into the ciliary body
T1c	The tumor is T1 in size and is not growing into the ciliary body but is growing outside of the eyeball. The part of the tumor that is outside the eyeball is 5millimeters (about 1/5 of an inch) or less across in size
T1d	The tumor is T1 in size and is growing into the ciliary body. It is also growing outside of the eyeball. The part of the tumor that is outside the eyeball is 5millimeters (about 1/5 of an inch) or less across in size
T2	Tumor size is one of the following: No more than 3millimeters deep and from 12.1 to 18.0 millimeters across From 3.1 to 6 millimeters deep and 9.1 to 15 millimeters across From 6.1 to 9.0 millimeters deep and no more than 12.0 millimeters across
T2a	The tumor is T2 in size and is not growing into the ciliary body or growing outside the eyeball
T2b	The tumor is T2 in size and is growing into the ciliary body
T2c	The tumor is T2 in size and is not growing into the ciliary body but is growing outside of the eyeball. The part of the tumor that is outside the eyeball is 5millimeters (about 1/5 of an inch) or less across in size
T2d	The tumor is T2 in size and is growing into the ciliary body. It is also growing outside of the eyeball. The part of the tumor that is outside the eyeball is 5millimeters (about 1/5 of an inch) or less across in size
T3	Tumor size is one of the following: 3.1 to 6 millimeters deep and between 15.1 and 18 millimeters across 6.1 to 9.0 millimeters deep and between 12.1 and 18 millimeters across From 9.1 to 12 millimeters deep and 18 millimeters or less across From 12.1 to 15 millimeters deep and 15 millimeters or less across
T3a	The tumor is T3 in size and is not growing into the ciliary body or growing outside the eyeball
T3b	The tumor is T3 in size and is growing into the ciliary body
T3c	the tumor is T3 in size and is not growing into the ciliary body but is growing outside of the eyeball. The part of the tumor that is outside the eyeball is 5millimeters (about 1/5 of an inch) or less across in size
T3d	The tumor is T3 in size and is growing into the ciliary body. It is also growing outside of the eyeball. The part of the tumor that is outside the eyeball is 5millimeters (about 1/5 of an inch) or less across in size.
T4	Tumor size is one of the following: Greater than 15 millimeters deep and any width Greater than 18 millimeters across and any depth Between 12.1 and 15.0 millimeters deep and between 15.1 and 18 millimeters across
T4a	The tumor is T4 in size and is not growing into the ciliary body or growing outside the eyeball
T4b	The tumor is T4 in size and is growing into the ciliary body
T4c	The tumor is T4 in size and is not growing into the ciliary body but is growing outside of the eyeball. The part of the tumor that is outside the eyeball is 5millimeters (about 1/5 of an inch) or less across in size
T4d	The tumor is T4 in size and is growing into the ciliary body. It is also growing outside of the eyeball. The part of the tumor that is outside the eyeball is 5millimeters (about 1/5 of an inch) or less across in size
T4e	The tumor is growing outside the eyeball with the part of the tumor that is outside the eyeball greater than 5millimeters across. The tumor can be any size

N categories for iris, ciliary body and choroidal melanomas

N classification	Nodal Mass
NX	Lymph node cannot be assessed
N1	Cancer has not been spread to nearby lymph nodes
N2	Cancer has spread to nearby lymph nodes

M categories for iris, ciliary body, and choroidal melanomas

M Classification	Definition
M0	Cancer has not spread to distant parts of the body
M1	Cancer has spread to distant parts of the body
M1a	The largest area of cancer spread is 3 centimeters (a little over an inch) across or smaller
M1b	The largest area of cancer spread is between 3.1 and 8 centimeters across (8 centimeters is a little over 3 inches)
M1c	The largest area of cancer spread is 8 centimeters or more across

Anatomic stage or prognostic groups of uveal melanoma

Stage	T	N	M
Stage 1	T1a	N0	M0
Stage IIA	T1b-d T2a	N0 N0	M0 M0
Stage IIB	T2b T3a	N0 N0	M0 M0
Stage IIIA	T2c-d T3b-c T4a	N0 N0 N0	M0 M0 M0
Stage IIIB	T3d T4b-c	N0 N0	M0 M0
Stage III C	T4d-e	N0	M0
Stage IV	Any T Any T	N0 Any N	M0 M1a-c