Another system in common use is the American Joint Commission on Cancer (AJCC) staging
system, which lumps levels and sites of tumor into convenient smaller categories. Table 1
shows the stages, as modified in 1988.
Eye Melanomas
Melanomas of the eye are classified by direct observation and ultrasound measurements into small, medium and large tumors, based on their diameter and elevation.
• Small tumors have a better prognosis and are often followed without removal to see how fast they are growing.
• Medium tumors are often followed, but there is some debate about whether this is the best course of action.
• Large melanomas are usually treated early, but if they are not significantly impairing vision they can also be
watched for a time.
If the rules that govern skin melanomas are correct, any size of eye tumor carries a significant hazard of permitting the tumor to reach the bloodstream (the eye has few lymph vessels). Since the ocular melanoma appears to be much more slow growing than skin melanoma and usually occurs in elderly people, however, it does not have the same degree of risk.
The appearance of eye melanoma cells under the microscope is also an indicator of outcome. Spindle-shaped cells are less malignant and patients almost always live 15 years. Melanoma cells resembling skin cells
