Melanoma of the Eye

Melanoma is a cancer of the pigmented cells of the body (melanocytes). It most commonly occurs in the skin but can develop in parts of the eye. Also known as ocular melanoma, melanoma of the eye occurs in six people per million, per year. It is more common in Caucasians or people with blue or green eyes. 

The cause of melanoma of the eye is unknown. There are no known modifiable lifestyle habits that have been connected to ocular melanoma, including diet, smoking, alcohol use or environmental exposures. Sun exposure is a debatable risk factor.

Test & Exams

A complete eye exam with dilation of the pupils is required to diagnose an ocular melanoma. The melanoma can occur either in the front of the eye or the back of the eye. The ophthalmologist will look for a yellow to brown tumor with certain features including size, thickness, nearness to the optic nerve and pigmentation. 

Symptoms

If you ever experience changes in your vision, flashes of light or new floaters, you should alert you ophthalmologist.

Freckles in the eye

Just like skin, the eye can develop pigmented lesions like moles or freckles. Most freckles in the eye are benign, but these lesions require yearly monitoring by an ophthalmologist since they have a small chance of converting to melanoma (cancer).

Exams and Tests

Ultrasound

Just like a mother sees her baby for the first time using ultrasound, an ocular ultrasound will be performed in the office to visualize the tumor. This consists of a cold jelly with a vibrating probe that is gently placed over the eyelid.

Fluorescein Angiography and Autofluorescence

A fluorescent dye is used to view blood vessels inside the eye and tumor. This is performed by injecting a dye into a vein in the arm. The dye is very different than dye used for CT or MRI and there is no radiation for this procedure. Autofluorescence of the tumor’s natural pigments is assessed simultaneously.

Treatment

The goals of treatment in order are:

  1. Save the patient’s life
  2. Save the eye
  3. Save and maximize vision

Treatment is tailored to each patient. Often a combination of treatments is used to achieve disease control. Treatment options may include a combination of local, systemic and/or radiation therapy.

Laser Therapy

A laser beam may be directed to areas of the tumor. Laser therapy is also used to treat other ophthalmic disease. This therapy requires pupil dilation.

Plaque Radiotherapy

Plaque radiotherapy is a type of radiation provided by UofL Physicians – Radiation Oncology that is applied to the tissue immediately next to the tumor. The plaque is about the size of a nickel and will be applied to the eye in the operating room. It stays on the eye for about 4 days before it is removed. Side effects may include progressive loss of vision, pain or glaucoma (raised eye pressure). 

Eye Injections

An eye injection has been shown to help decrease loss of vision due to radiation therapy and will be given at the time of plaque removal. The injection will likely be repeated every 4 months for 2 years to minimize radiation complications.

Enucleation

Many patients are concerned about loss of the eye, or enucleation. Removal of the eye is reserved for very large tumors that are not amenable to radiation or if severe pain or loss of vision occurs. In 15% of cases, the eye has to be removed due to radiation complications. 

Does ocular melanoma affect the rest of the body?

Systemic testing

There is a small risk of ocular melanoma affecting other areas of the body. Our eye specialists coordinate with UofL Physicians – Medical Oncology/Hematology oncologists, Donald M. Miller, MD, PhD and Jason Chesney, MD, PhD at the James Graham Brown Cancer Center to obtain imaging studies such as CT and PET scans, as well as MRI when needed. These tests are performed in the hospital setting to evaluate other organ systems. An ultrasound of the liver and blood work will also be a necessary part of the systemic work up. Continued follow up with the medical oncologist is also important and will likely be completed twice yearly for blood work, and once a year for a liver ultrasound.

Genetic testing

Ocular melanoma is separated into two types based on its genetic makeup. A biopsy of the tumor may be taken and sent for genetic testing to identify its class. The two classes include:

  • Class 1—Tumors that have a low risk of spreading to other areas of the body, also called metastasis
  • Class 2—Tumors that have a relatively higher risk of metastasis