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Staging (Melanoma Uveal)
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Staging (Melanoma Uveal)
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Pathologic Staging (pTNM) CAP approved Ophthalmic – Uveal Melanoma 4.0.0.0 (AJCC 8th Ed.)
TNM Descriptors (required only if applicable) (select all that apply)
___ m (multiple primary tumors)
___ r (recurrent)
___ y (posttreatment)
Primary Tumor (pT)
Iris ___ pTX: Primary tumor cannot be assessed
___ pT0: No evidence of primary tumor
___ pT1: Tumor limited to the iris
___ pT1a: Tumor limited to the iris not more than 3 clock hours in size
___ pT1b: Tumor limited to the iris more than 3 clock hours in size
___ pT1c: Tumor limited to the iris with secondary glaucoma
___ pT2: Tumor confluent with or extending into the ciliary body, choroid, or both
___ pT2a: Tumor confluent with or extending into the ciliary body, without secondary glaucoma
___ pT2b: Tumor confluent with or extending into the ciliary body and choroid, without secondary glaucoma ___ pT2c: Tumor confluent with or extending into the ciliary body, choroid, or both, with secondary glaucoma
___ pT3: Tumor confluent with or extending into the ciliary body, choroid, or both, with scleral extension
___ pT4: Tumor with extrascleral extension
___ pT4a: Tumor with extrascleral extension =5 mm in largest diameter
___ pT4b: Tumor with extrascleral extension >5 mm in largest diameter
Note: Iris melanomas originate from, and are predominantly located in, this region of the uvea. If less than half the tumor volume is located within the iris, the tumor may have originated in the ciliary body, and consideration should be given to classifying it accordingly.
Ciliary Body and Choroid
___ pTX: Primary tumor cannot be assessed
___ pT0: No evidence of primary tumor
___ pT1: Tumor size category 1
___ pT1a: Tumor size category 1 without ciliary body involvement and extraocular extension
___ pT1b: Tumor size category 1 with ciliary body involvement
___ pT1c: Tumor size category 1 without ciliary body involvement but with extraocular extension =5 mm in largest diameter ___ pT1d: Tumor size category 1 with ciliary body involvement and extraocular extension =5 mm in largest diameter
___ pT2: Tumor size category 2
___ pT2a: Tumor size category 2 without ciliary body involvement and extraocular extension
___ pT2b: Tumor size category 2 with ciliary body involvement
___ pT2c: Tumor size category 2 without ciliary body involvement but with extraocular extension =5 mm in largest diameter ___ pT2d: Tumor size category 2 with ciliary body involvement and extraocular extension =5 mm in largest diameter
___ pT3: Tumor size category 3
___ pT3a: Tumor size category 3 without ciliary body involvement and extraocular extension
___ pT3b: Tumor size category 3 with ciliary body involvement
___ pT3c: Tumor size category 3 without ciliary body involvement but with extraocular extension =5 mm in largest diameter
___ pT3d: Tumor size category 3 with ciliary body involvement and extraocular extension =5 mm in largest diameter
___ pT4: Tumor size category 4
___ pT4a: Tumor size category 4 without ciliary body involvement and extraocular extension
___ pT4b: Tumor size category 4 with ciliary body involvement
___ pT4c: Tumor size category 4 without ciliary body involvement but with extraocular extension =5 mm in largest diameter
___ pT4d: Tumor size category 4 with ciliary body involvement and extraocular extension =5 mm in largest diameter
___ pT4e: Any tumor size category with extraocular extension >5 mm in largest diameter Notes: 1. Primary ciliary body and choroidal melanomas are classified according to the four tumor size categories defined in Figure 3. 2. In clinical practice, the largest tumor basal diameter may be estimated in optic disc diameters (DD; average: 1 DD = 1.5 mm), and tumor thickness may be estimated in diopters (average: 2.5 diopters = 1 mm). Ultrasonography and fundus photography are used to provide more accurate measurements. 3. When histopathologic measurements are recorded after fixation, tumor diameter and thickness may be underestimated because of tissue shrinkage.
Regional Lymph Nodes (pN)
___ pNX: Regional lymph nodes cannot be assessed
___ pN0: No regional lymph node metastasis
___ pN1: Regional lymph node metastasis or discrete tumor deposits in the orbit
___ pN1a: Metastasis in one or more regional lymph node(s)
___ pN1b: No regional lymph nodes are positive, but there are discrete tumor deposits in the orbit that are not contiguous to the eye. (choroidal and ciliary body)
Distant Metastasis (pM) (required only if confirmed pathologically in this case)
___ pM1: Distant metastasis ___ pM1a: Largest diameter of the largest metastasis =3 cm
___ pM1b: Largest diameter of the largest metastasis 3.1-8.0 cm
___ pM1c: Largest diameter of the largest metastasis =8.1 cm Specify sites(s), if known: _________________________________