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Eye Cancer: Cancers of Conjunctiva

Squamous cell carcinoma: This is the most frequently occurring type of conjunctival eye cancer. It can affect the area around the cornea on the eye surface or the inside conjunctival layer of the eyelids. It has a very low risk of spreading to the lymph nodes.  

This eye cancer is most often treated with surgery with preservation of the eye. Supplemental cryotherapy (freezing treatment) is given to the edges of surgical area at the time of surgery. Sometimes topical chemotherapy (chemo drops) are used after surgery. In aggressive recurrent cases of conjunctival squamous cell carcinoma, the eye may have to be removed.

Melanoma: Melanoma can occur on the conjunctiva on the surface of the eyeball (bulbar conjunctiva) or on the conjunctival covering of the inside of the eyelid (palpebral conjunctiva). Conjunctival melanomas have a risk of spreading to lymph nodes and to other parts of the body. This risk is higher for thicker melanomas.

Surgical removal of the tumor with cryotherapy to the surgical margins is the most common treatment. Sentinel lymph node biopsy is done to find early microscopic metastasis in the lymph nodes that drain the conjunctival melanoma (please link this to our clinical trials site for ophthalmology). This procedure helps with staging of this eye cancer and also with offering additional treatments for more advanced stages as soon as possible.

Sometimes our doctors use topical chemotherapy (chemo drops) after surgery to lessen the likelihood of recurrence. It is very important that surgeons and pathologists familiar with this rare form of melanoma do the surgery and evaluation of the surgical specimen; otherwise, there is a higher risk of recurrence and valuable information about prognosis of melanoma can be lost.

Mucosa-associated lymphoid tissue lymphoma (MALT): This form of eye cancer occurs on the surface covering of the eye and the inside layer of eyelid (conjunctiva). It is a low-grade (slow-growing) form of B-cell lymphoma that usually shows up as a salmon-colored (light orange) growth on the surface of the eye.  

The first step is to biopsy the growth to confirm it is lymphoma.  Evaluation of the biopsy specimen is very important. Expert pathologists at MD Anderson specialize in diagnosing conjunctival MALT lymphoma using the biopsy from the eye.

Treatments for this eye cancer may include radiation therapy or monoclonal antibody treatment or other types of chemotherapy. Our ophthalmologists work closely with medical oncologists and radiation oncologists to determine the best treatment options for each patient.

If you have been diagnosed with eye cancer, we’re here to help. Call 1-877-632-6789 to make an appointment or request an appointment online.

Why Choose MD Anderson?

  • Latest eye cancer treatments, including specialized surgical techniques to remove cancer but save the eye, proton therapy, targeted therapies, advanced reconstructive surgery for eyelid and orbital cancer
  • Advanced diagnostic techniques including sentinel lymph node biopsy, ultrasound biomicroscopy, confocal biomicroscopy and optical coherence tomography (OCT)
  • Skilled, highly specialized eye surgeons and reconstructive surgeons who have dedicated many years of their career to exclusively treat cancer
  • We treat more eye cancers than most centers
  • Team approach to treating eye cancers
  • Clinical trials of leading-edge treatments for eye cancer

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Conjunctival Cancer Staging

(source: American Joint Committee on Cancer)

If you are diagnosed with eye cancer, your doctor will determine the stage of the disease. Staging is a way of classifying how much disease is in the body and where it has spread when it is diagnosed. This information helps your doctor plan the best type of treatment for you. Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.

The most common staging system used for ocular cancers 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.

Cancers of the conjunctiva are staged as follows: 

T categories:

  • TX: Primary tumor cannot be assessed
  • T0: No evidence of primary tumor
  • Tis: Carcinoma in situ
  • T1: Tumor is 5 mm or smaller in greatest dimension
  • T2: Tumor is larger than 5 mm in greatest dimension, without invasion of adjacent structures
  • T3: Tumor invades adjacent structures (excluding orbit)
  • T4: Tumor invades the orbit with or without further extension
  • T4a: Tumor invades orbital soft tissues, without bone invasion
  • T4b: Tumor invades bone
  • T4c: Tumor invades adjacent paranasal sinuses
  • T4d: Tumor invades brain

N categories: 

  • NX: Regional lymph nodes cannot be assessed
  • N0: No regional lymph node metastasis
  • N1: Regional lymph node metastasis

M categories:

  • M0: No distant metastasis
  • M1: Distant metastasis

Malignant Conjunctival Melanoma Staging

Quadrants of the eye are defined by clock hour, starting at the limbus (e.g. 6,9,12 & 3) extending from the central cornea to and beyond the eyelid margin.  This will bisect the caruncle.

T categories: 

  • TX: Primary tumor cannot be assessed
  • T0: No evidence of primary tumor
  • Tis: Melanoma confined to the conjunctival epithelium*
  • T1: Malignant conjunctival melanoma of the bulbar conjunctiva
  • T1a: Less than or equal to 1 quadrant
  • pT1a: Melanoma of the bulbar conjunctiva not greater than 0.5 mm in thickness with invasion of the substantia propria
  • T1b: greater than 1 but less than 2 quadrants
  • pT1b: Melanoma of the bulbar conjunctiva  greater than 0.5 mm but  less than or equal to 1.5 mm in thickness with invasion of the substantia  propria
  • T1c: Greater than 2 but less than 3 quadrants
  • pT1: Melanoma of the bulbar conjunctiva greater than 1.5 mm in thickness with invasion of the substantia propria
  • T1d: greater than 3 quadrants
  • T2: Malignant conjunctival melanoma of the non-bulbar (palpebral, forniceal caruncular)
  • T2a: Non-caruncular, less than or equal to 1 quadrant
  • pT2a: Melanoma of the palpebral, forniceal or caruncular conjunctiva not greater than0.5 mm in thickness with invasion of the substantia propria
  • T2b: Non-caruncular, greater than1 quadrant
  • pT2b: Melanoma greater than 0.5 but not greater than1.5 mm in thickness  with invasion of the substantia propria
  • T2c: Any caruncular, less than or equal to 1 quadrant
  • pT2c: Melanoma of the palpebral, forniceal caruncular conjunctiva greater than1.5 mm in thickness with invasion of the substantia propria
  • T2d: Any caruncular, greater than 1 quadrant
  • T3: Any malignant conjunctival melanoma with local  invasion
  • pT3: Melanoma invades the eye, eyelid, nasolacrimal system, sinuses or orbit
  • T3a: Globe
  • T3b: Eyelid
  • T3c: Orbit
  • T3d: Sinus
  • T4: Tumor invades the central nervous system
  • pT4: Melanoma invades the central nervous system

N categories: 

  • NX: Regional lymph nodes cannot be assessed
  • N0a (biopsied): No regional lymph node metastasis, biopsy performed
  • N0b (not biopsied): No regional lymph node metastasis, biopsy not performed
  • N1 : Regional lymph node metastasis
  • N1a: Micrometastasis
  • N1b: Macrometastasis

M categories:

  • M0: No distant metastasis
  • M1: Distant metastasis

Conjunctival Lymphoma Staging

T categories:

  • TX: Lymphoma extent not specified
  • T0: No evidence of lymphoma
  • T1: Lymphoma involving the conjunctiva alone without orbital involvement
  • T1a: Bulbar conjunctive only
  • T1b: Palpebral conjunctiva ± fornix ± caruncle
  • T1c: Extensive conjunctival involvement
  • T2: Lymphoma with orbital involvement ± any conjunctival involvement
  • T2a: Anterior orbital involvement (± conjunctival involvement)
  • T2b: Anterior orbital involvement (± conjunctival + lacrimal involvement)
  • T2c: Posterior orbital involvement (± conjunctival involvement ± anterior involvement ± any extraocular muscle involvement)
  • T2d: Nasolacrimal drainage system involvement (± conjunctival involvement but not including nasopharynx)
  • T3: Lymphoma with pre-septal eyelid involvement (defined above) ± orbital involvement ± conjunctival involvement
  • T4: Orbital adnexal lymphoma extending beyond orbit to adjacent structures such as bone and brain
  • T4a: Involvement of nasopharynx
  • T4b: Osseous involvement (including periosteum)
  • T4c: Involvement of maxillofacial, ethmoidal and/or frontal sinuses
  • T4d: Intracranial spread

N categories:

  • NX: Regional lymph nodes cannot be assessed
  • N0: No evidence of lymph node involvement
  • N1: Involvement of ipsilateral regional lymph nodes
  • N2: Involvement of contralateral or bilateral regional lymph nodes
  • N3: Involvement peripheral lymph nodes not draining ocular adnesal region
  • N4: Involvement of central lymph nodes

M categories:

  • M0: No evidence of involvement of other extranodal sites
  • M1a: Noncontiguous involvement of tissues or organs external to the ocular adnexa
  • M1b: Lymphomatous involvement of the bone marrow
  • M1c: Both M1a and M1b involvement

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