Fitzpatrick skin type and relationship to ocular melanoma

Fitzpatrick Skin Type (FST) is a classification for skin color, ranging from FST I (lightest skin tone) to FST VI (darkest skin tone), used to study risk and outcomes of cutaneous melanoma. Ocular melanoma includes primary melanoma in the eye region, including the conjunctiva and the uvea. There is little literature on the relationship of FST with ocular melanoma. Regarding conjunctival melanoma, one study evaluated 540 eyes with conjunctival melanoma and found that patients most often demonstrated FST I or II (85%). A comparison between FST I vs. II vs. III-VI showed that FST did not impact 5-year outcomes of metastasis or death. Regarding uveal melanoma, three separate studies evaluated 854 eyes with uveal melanoma and FST data. The first study explored the relationship of FST (FST I vs. II vs. III-V) with iris pigmentation. Patients with FST III-V and brown iris color were found to have larger mean tumor thickness (p=0.003) and basal diameter (p=0.001). The second study identified that patients with FST I demonstrated more high-grade tumor genetic mutations (odds ratio (OR) 2.34, p=0.002) whereas those with FST III-V demonstrated low-grade tumor genetic mutations (OR 2.26, p=0.002). The third report revealed patients with FST I showed greatest 10-year risk for metastasis (25% vs. 15% vs. 14%, p=0.02) and death (9% vs. 3% vs. 4%, p=0.04), perhaps related to advanced tumor genetic mutations. Herein, we summarize the published literature on the relationship of FST in 540 eyes with conjunctival melanoma and in 854 eyes with uveal melanoma.