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Melanoma Uveal
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Melanoma Uveal
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Melanoma Uveal (SOMEL)
Specimen and Surgical Procedure
Laterality........................................................................................
Response Options:
___ Right
___ Left
___ Unspecified
Procedure.......................................................................................
Response Options:
___ Local resection
___ Enucleation
___ Limited exenteration
___ Complete exenteration
___ Other (specify): ____________
___ Not specified
Tumor
Tumor site (macroscopic examination/transillumination)........................
Response Options:
___ Cannot be determined
___ Superotemporal quadrant of globe
___ Superonasal quadrant of globe
___ Inferotemporal quadrant of globe
___ Inferonasal quadrant of globe
___ Between ___ and ___ o'clock
___ Other (specify): ___________
Tumor site after sectioning...............................................................
Response Options:
___ Cannot be determined
___ Superonasal
___ Inferonasal
___ Superotemporal
___ Inferotemporal
Tumor size after sectioning (greatest basal diameter).......................... ___ mm
Tumor involvement of other ocular structures.....................................
Response Options:
___ Cannot be determined
___ Sclera
___ Vortex vein(s)
___ Optic disc
___ Vitreous
___ Choroid
___ Ciliary body
___ Iris
___ Lens
___ Anterior chamber
___ Extrascleral extension (anterior)
___ Extrascleral extension (posterior)
___ Angle/Schlemm's canal
___ Optic nerve
___ Retina
Growth pattern............................................................................
Response Options:
___ Cannot be determined
___ Solid mass
___ Dome shape
___ Mushroom shape
___ Diffuse (ciliary body ring)
___ Diffuse (flat)
Histologic type............................................................................
Response Options:
___ Spindle cell melanoma (>90% spindle cells)
___ Mixed cell melanoma (>10% epithelioid cells and <90% spindle cells)
___ Epithelioid cell melanoma (>90% epithelioid cells)
Microscopic tumor extension (Scleral involvement)..........................
Response Options:
___ Cannot be determined
___ None
___ Extrascleral
___ Intrascleral
Margins.....................................................................................
Response Options:
___ Cannot be assessed
___ No melanoma at margins
___ Extrascleral extension (for enucleation specimens)
___ Other margin(s) involved (specify): ______________
Pathologic stage........................................................................ pT__N__M__