Introduction of the 7th Edition Eyelid Carcinoma Classification System From the American Joint Committee on Cancer–International Union Against Cancer Staging Manual

Context.—The American Joint Committee on Cancer (AJCC) and the International Union Against Cancer commissioned the Ophthalmic Oncology Task Force to modify and update the ophthalmic chapters of the 7th edition of the AJCC Cancer Staging Manual. Objective.—To review the existing eyelid carcinoma chapter in the 6th edition of the AJCC Cancer Staging Manual for its clinical and research utility and to seek evidence-based revisions with the strongest medical foundation to use in updating the anatomically based TNM cancer staging system manual. Data Sources.—The 4-year Ophthalmic Oncology Task Force consisted of 45 tumor specialists from 10 countries and an extensive internal and external peer review process. The 10-member Carcinoma of the Eyelid team included a diverse group of international authors. The group included extensive representation by clinicians, pathologists, surgeons, radiation therapists, and cancer registrars, all with advanced, ophthalmic cancer–related areas of subspecialty. Data sources included the above expertise applying a worldwide medical literature search, with no discrimination based on language, country of origin, discipline source, specialty source, or surgical practice. Conclusions.—Revisions were made to the TNM classification in areas with the strongest basis in evidence and practical effect. Lymph node staging data were expanded markedly to reflect its significant prognostic value. T3 and T4 were redefined and stage groupings were added that applied current understanding in tumor biology, respected site-specific risk factors, and provided greater correlation with the common language of the overall AJCC Cancer Staging Manual. Evidence-based biomarkers and data-field modifiers were included to capture additional pathologically and clinically substantiated prognostic factors.