PurposeTo summarize a Finnish population-based study on conjunctival melanoma to better understand its behavior and to improve treatment.MethodsData from 85 patients diagnosed from 1967 to 2000 were ascertained from cancer registry and patient charts. Data were analyzed using advanced survival statistics.ResultsThe age-adjusted incidence of conjunctival melanomas doubled from 0.4 to 0.8 per million during the study period. The cumulative 5-year and 10-year probabilities of survival were 83% (95% CI, 72–89) and 67% (95% CI, 54–77), respectively, considering melanoma deaths. Non-limbal location of the primary tumour (hazard ratio, 4.6,P < 0.001), thickness (HR 1.3 for each 1 mm increase, P = 0.007) and local recurrence (HR 1.8 for each recurrence, P < 0.001) were associated with decreased survival. No histopathologic factor significantly contributed to estimating survival after considering tumor location and size. In 9 (45%) of 20 patients with an established metastatic pattern the initial metastasis was regional lymphatic. The 10-year cumulative incidences of regional and systemic metastases were 11% and 18%. Regional metastasis was more frequent if the primary was >2 mm thick and if the tumor was non-limbal. Median survival after initial regional and systemic metastasis was 30 and 8 months (P = 0.012).ConclusionsThe incidence of conjunctival melanoma is increasing analogous to cutaneous melanoma. Every attempt should be made to prevent local recurrence. Patients with high risk characteristics for regional lymphatic metastasis might benefit from sentinel lymph node biopsy.