{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:30:12Z","timestamp":1790101812940,"version":"4.0.1"},"reference-count":46,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2024,12,18]],"date-time":"2024-12-18T00:00:00Z","timestamp":1734480000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Myrna and John Daniels Charitable Trust","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"The Eye Cancer Foundation","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2024,11,7]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>To reveal clinical findings related to metastatic conjunctival melanoma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>10 ophthalmic oncology centres (9 countries and 4 continents) shared data to create a large clinical case series. The main outcome measures were the incidence and cumulative risk of systemic metastasis, study mortality rates and Kaplan-Meier patient mortality after developing conjunctival melanoma metastasis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 288 patients, 29 developed metastasis. Five had metastasis at presentation, were American Joint Committee on Cancer (AJCC) cT3-category and exhibited tumour-surface ulceration. Four of five (80%) had melanotic tumours with plical and\/or caruncular involvement and died within 1 year. One survived 21 months. In contrast, 24 developed metastases during follow-up (mean 4.6\u00b13.2 years). Their primary tumours were cT1 (n=13\/24, 54.1%), cT2 (n=6\/24, 25%), cT3 (n=2\/24, 8.3%) and 3 cTx (12.5%) at presentation. Death had occurred in 17 patients (n=17\/24, 71%) by the end of the study. The cumulative risk of systemic metastasis after treatment was 0.4% (95% CI 0.6% to 2.9%) at 1 year, 8.6% (95% CI 5.1% to 14.3%) at 5 years and 22.3% (95% CI 14.5% to 33.5%) at 10\u2009years. Each increase in AJCC cT category was associated with an 89% higher risk for metastasis (HR=1.89, p&lt;0.001). Among all 29 patients who developed metastasis, those who presented with AJCC cT3 disease were at highest risk (p&lt;0.001). Liver and lung (n=13\u2009each) were the most reported metastatic sites.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Metastatic conjunctival melanoma was found in 10% of conjunctival melanoma patients. Tumour-specific characteristics including AJCC cT3-category, conjunctival location and surface ulceration were associated with metastatic risk. 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