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Most eye cancers are melanomas (also known as ocular melanomas or intraocular melanomas). After someone is diagnosed with eye cancer, doctors will try to figure out how big it is, how far it has grown into nearby structures, and if it has spread. This process is called staging.
The stage of an eye cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. Doctors also use a cancer's stage when talking about survival statistics.
The cancer stage is based on the results of eye exams, imaging tests (ultrasound, CT or MRI scan, etc.), and any other tests that are done. (See Tests for Eye Cancer.)
A staging system is a standard way for the cancer care team to describe how far a cancer has spread. The most common systems used to describe the stages of eye melanomas are the American Joint Committee on Cancer (AJCC) TNM system and the system used by the Collaborative Ocular Melanoma Study (COMS) group.
Most eye melanomas start in the uvea, which includes the iris, ciliary body, and choroid. (See What Is Eye Cancer?) The system below is for these uveal melanomas.
Less often, melanomas can start in other areas in or around the eye, some of which have their own staging systems (such as conjunctival melanoma). Talk to your doctor to learn more about your stage if you have a less common type of eye melanoma.
The AJCC TNM system for uveal melanoma is based on 3 key pieces of information:
Numbers or letters appear after T, N, and M to provide more details about each of these factors. Higher numbers or letters mean the cancer is more advanced.
The T categories for ciliary body and choroidal melanomas are different from the T categories for iris melanomas. But the N and M categories are the same for melanomas in all 3 parts of the uvea.
Ciliary body and choroidal melanomas are divided into 4 main T categories (T1 to T4), based on the diameter (width) and the thickness of the tumor. T1 tumors are the smallest; T4 tumors are the largest. Each of these categories is then broken down further, based on how far the tumor has grown.
TX: The primary tumor cannot be assessed; information not known.
T0: No evidence of a primary tumor.
T1 tumors:
T2 tumors:
T3 tumors:
T4 tumors:
TX: The primary tumor cannot be assessed; information not known.
T0: No evidence of a primary tumor.
T1: Tumor is only in the iris.
T2: Tumor has grown into the ciliary body or choroid (or both).
T3: Tumor has grown into the ciliary body and/or choroid and into the sclera.
T4: Tumor extends outside the eyeball.
The N categories are the same for melanomas of the iris, ciliary body, and choroid.
NX: Lymph nodes cannot be assessed.
N0: Cancer has not spread to nearby lymph nodes.
N1: Cancer has spread to nearby lymph nodes, or it has spread as small cancer deposits in other parts of the eye.
The M categories are the same for iris, ciliary body, and choroidal melanoma.
M0: Cancer has not spread to distant parts of the body.
M1: Cancer has spread to distant parts of the body.
To assign an overall stage, the T, N, and M categories are combined in a process called stage grouping. The stages are described by Roman numerals from I (the least advanced) to IV (the most advanced). Some stages are further divided with letters.
Stage |
TNM categories |
Stage I |
T1a, N0, M0 |
Stage IIA |
T1b to T1d, N0, M0 or T2a, N0, M0 |
Stage IIB |
T2b or T3a, N0, M0 |
Stage IIIA |
T2c or T2d, N0, M0 or T3b or T3c, N0, M0 or T4a, N0, M0 |
Stage IIIB |
T3d, N0, M0 or T4b or T4c, N0, M0 |
Stage IIIC |
T4d or T4e, N0, M0 |
Stage IV |
Any T, N1, M0 or Any T, any N, M1 |
This staging system for uveal melanoma can be very complex. To learn more about it and how it might apply to your cancer, ask your doctor to explain it to you in a way you understand.
Doctors might also describe eye melanoma by its grade (G). The grade describes how abnormal the cancer cells look under a microscope.
The grade is not used to help determine the stage of the cancer, but it may help the doctor predict how likely it is that the cancer will spread. In general, the lower the tumor’s grade, the better the outlook.
After a biopsy or surgery to remove the tumor, doctors may look at the types of cells in the tumor. This is called its histopathology. Three main types of histopathology patterns may be seen:
Generally, a tumor made up of only (or mostly) spindle cells tends to have a better outlook (prognosis) and is given a lower grade.
The TNM system is very detailed, but when deciding on treatment doctors may use the simpler system devised by the COMS group, which has done most of the clinical research on how to treat intraocular melanoma. This system is only based on tumor size. It divides eye melanomas into small, medium, and large:
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
American Joint Committee on Cancer. Uveal Melanoma. In: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017: 805-817.
National Cancer Institute. Intraocular (Uveal) Melanoma Treatment (PDQ®)–Health Professional Version. 2024. Accessed at https://www.cancer.gov/types/eye/hp/intraocular-melanoma-treatment-pdq on April 9, 2025.
Last Revised: May 5, 2025
American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.
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