# Conjunctival melanoma

Source: https://onco.cc/cancers/conjunctival-melanoma/  
OnCo record `conjunctival-melanoma` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Conjunctival melanoma is a rare melanoma of the clear membrane over the white of the eye, usually growing out of a flat brown patch called primary acquired melanosis. It is removed with a margin and the edges frozen or treated with chemotherapy drops; about one in five spread within five years, and advanced disease is treated like skin melanoma with targeted or immune drugs.

## Summary

Conjunctival melanoma is a mucosal-surface melanoma of the eye, distinct from uveal melanoma in origin, genetics and behaviour and classified with the conjunctival tumours in the WHO eye classification. In 382 consecutive patients, the melanoma arose from primary acquired melanosis in 74 percent, from a pre-existing naevus in 7 percent and de novo in 19 percent; melanoma-related metastasis at five (ten) years occurred in 19 (25) percent of tumours arising from primary acquired melanosis, 10 (26) percent from naevus and 35 (49) percent de novo, and de novo origin and palpebral location predicted metastasis (Shields 2011). In Denmark the incidence was 0.5 per million a year and rising, with BRAF mutations in 39 of 111 tumours (35 percent) (Acta Ophthalmologica 2016).

How it differs from its parent: it behaves and mutates like cutaneous rather than uveal melanoma (BRAF, NRAS, NF1 rather than GNAQ and GNA11), it spreads to regional lymph nodes first, and its local treatment is ophthalmic surgery with adjuvant cryotherapy or topical chemotherapy rather than wide skin excision.

How common: about 0.5 per million a year (Acta Ophthalmologica 2016).

Treatment: excision without touching the tumour, with cryotherapy to the margins and topical mitomycin or interferon for the associated melanosis, as in the ophthalmic series; sentinel node biopsy in selected cases; metastatic disease treated as on the melanoma page with BRAF and MEK inhibitors when mutated and checkpoint inhibitors otherwise (Shields 2011 for the surgical series).

## Fields

- Kind: Cancer
- Last checked: 2026-09-24
- Also known as: Melanoma of the conjunctiva; Ocular surface melanoma; Conjunctival malignant melanoma
- Tags: subtype-page; wave4; rare
- Group: skin
- Burden: About 0.5 cases per million a year in Denmark, rising over 1960 to 2012 (Acta Ophthalmologica 2016); the largest clinical series holds 382 consecutive patients (Shields 2011). It is separate from uveal melanoma, which GLOBOCAN also does not count apart.
- Subtypes: Conjunctival melanoma arising from primary acquired melanosis with atypia (74 percent); Conjunctival melanoma arising from a naevus (7 percent); De novo conjunctival melanoma (19 percent; highest metastatic risk); Palpebral, forniceal or caruncular conjunctival melanoma (non-bulbar; worse outlook); distinct from uveal melanoma
- Biomarkers: BRAF V600E (about 35 percent), NRAS and NF1 mutations; Tumour origin and location (bulbar versus non-bulbar); Tumour thickness and ulceration; Sentinel node status in selected cases

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/conjunctival-melanoma/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/conjunctival-melanoma/#overview
- What it is (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/conjunctival-melanoma/#what-it-is [4 subtypes]
- Finding it (on the hub): How it shows itself, how it is confirmed, what screening exists, and the biomarkers clinicians test for. https://onco.cc/cancers/conjunctival-melanoma/#finding-it [4 biomarkers]
- Treating it (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/conjunctival-melanoma/#treating-it [2 settings, 1 decision with options]
- Evidence (on the hub): Trials recruiting now, the landmark trials, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/conjunctival-melanoma/#evidence
- The science (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/conjunctival-melanoma/#science [3 targets]
- Where you are (own page): Cases by country, the UK and NHS pathway and other country lenses, and the expert centres with trials on record. https://onco.cc/cancers/conjunctival-melanoma/where-you-are/
- Living with it (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/conjunctival-melanoma/#living-with-it [10 questions, 5 red cards]
- What is coming (own page): Everything in development, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/conjunctival-melanoma/coming/ [5 medicines]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/conjunctival-melanoma/data/ [17 connected records]

## Standard of care

- Localised: No-touch excision with cryotherapy to the margins and topical mitomycin or interferon for associated melanosis; sentinel node biopsy in selected cases. ([Melanoma](https://onco.cc/cancers/melanoma/), [Mitomycin C](https://onco.cc/drugs/mitomycin/))
- Metastatic: Treated as on the melanoma page: BRAF and MEK inhibitors when mutated, checkpoint inhibitors otherwise. ([Melanoma](https://onco.cc/cancers/melanoma/), [Dabrafenib](https://onco.cc/drugs/dabrafenib/), [Trametinib](https://onco.cc/drugs/trametinib/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/))

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Conjunctival_melanoma
- NCI PDQ: intraocular (uveal) melanoma treatment: https://www.cancer.gov/types/eye/patient/intraocular-melanoma-treatment-pdq
- Shields 2011, Ophthalmology: conjunctival melanoma outcomes by tumour origin in 382 consecutive cases: https://doi.org/10.1016/j.ophtha.2010.06.021
- Acta Ophthalmologica 2016: BRAF mutations, incidence and prognosis of conjunctival melanoma in Denmark: https://doi.org/10.1111/aos.13007

## Connected records

- cancers: [Acral melanoma](https://onco.cc/cancers/acral-melanoma/), [Adamantinoma of bone](https://onco.cc/cancers/adamantinoma/), [Melanoma](https://onco.cc/cancers/melanoma/), [Mucosal melanoma](https://onco.cc/cancers/mucosal-melanoma/), [Uveal melanoma](https://onco.cc/cancers/uveal-melanoma/)
- targets: [BRAF](https://onco.cc/targets/braf/)
- drugs: [Dabrafenib](https://onco.cc/drugs/dabrafenib/), [Mitomycin C](https://onco.cc/drugs/mitomycin/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Trametinib](https://onco.cc/drugs/trametinib/)

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JSON: https://onco.cc/api/v1/entities/conjunctival-melanoma.json