Eye Cancer: Intraocular (Uveal) Melanoma Treatment

The signs of eye cancer are not always present. Your ophthalmologist may recommend an eye exam to diagnose eye cancer and will examine the outside of your eye for enlarged blood vessels, which could indicate the presence of a tumor inside your eye. Then, using instruments, your ophthalmologist will examine the inside of your eye.

Eye cancer symptoms include: 

• Seeing bright flashes or eye floaters
• A shift in how the eyeball is seated in the socket
• Loss of vision in a segment of your field of vision
• Other vision issues, such as blurry vision or unexpected vision loss
• Developing a black patch on the colored portion of the eye
• Modification in the pupil's appearance or size
• Alteration in the eyeball's insertion into the socket
• Bulging of the eye
• Eye pain
• Retinal detachment (specific to melanoma in the choroid)

There are four size categories for ciliary body and choroid intraocular melanoma. The category is determined by the tumor's width and thickness. The tiniest tumors go into category 1, and the largest into category 4.

• Category 1: The tumor has a maximum width of 12 mm and a maximum thickness of 3 mm, or it has a maximum width of 9 mm and a maximum thickness of 3.1 to 6 mm.
• Category 2: The tumor is between 9.1 and 15 mm wide and 3.1 to 6 mm thick, between 12.1 and 18 mm wide and not more than 3 mm thick or between 6.1 and 9 mm thick and not wider than 12 mm.
• Category 3: The tumor is 15.1 to 18 mm wide and 3.1 to 6 mm thick, 12.1 to 18 mm wide and 6.1 to 9 mm thick, not more than 18 mm wide and 9.1 to 12 mm thick or not more than 15 mm wide and 12.1 to 15 mm thick.
• Category 4: The tumor is more than 18 m wide and may be of any thickness, 15.1 to 18 mm wide and more than 12 mm thick or not more than 15 mm wide and more than 15 mm thick.

Five types of standard treatment are used to treat intraocular melanoma, which include

• Surgery: The most common form of treatment for intraocular melanoma. Your physician could use the following surgical techniques:
  • Resection: Surgery to remove the tumor along with some nearby healthy tissue.
  • Enucleation: Surgery to remove the eye and a segment of the optic nerve. Enucleation is performed if there is no possibility of saving the vision and the tumor is large, has spread to the optic nerve, or is creating too much pressure inside the eye. Usually, after surgery, the person is fitted with an artificial eye that is the same size and color as the other eye.
  • Exenteration: Procedure to remove the eye and eyelid, as well as the fat, muscles, and nerves in the eye socket. Following surgery, the person might be fitted with a face prosthesis or an artificial eye that is the same size and color as the other eye.
• Watchful waiting: The term "watchful waiting" describes the practice of closely monitoring a person’s status without starting any therapy until symptoms or indicators appear or change. Over time, photographs are taken to track variations in the tumor's size and growth rate. Watchful waiting is used to treat people who have no symptoms or signs that a tumor is developing. Additionally, it is used when the tumor only affects one eye with functional vision.
• Radiation therapy: Uses high-energy radiation, such as X-rays or other types of radiation, to either eradicate or slow the growth of cancer cells. There are two types of radiation therapy:
  • In external radiation therapy, radiation is directed toward the tumor through a device outside the body. Certain delivery techniques for radiation therapy can minimize the risk of harming neighboring healthy tissue. Following are some examples of these external radiation therapy forms:
    • Charged-particle external beam radiation therapy
    • Gamma knife therapy
  • Internal radiation therapy uses radioactive materials by inserting needles, seeds, wires, or catheters directly into or close to cancer. Radiation therapy can harm healthy tissue, but specific delivery methods can reduce this risk of damaging healthy tissues. The following may be part of this form of internal radiation therapy:
    • Localized plaque radiation therapy

The radiation therapy regimen is determined by the type and stage of the cancer being treated. Treatment of intraocular melanoma involves both external and internal radiation therapy.

• Photocoagulation: A technique that uses laser light to disrupt the blood vessels that feed the tumor and kills the tumor cells. Photocoagulation may be used to remove small tumors. This is often referred to as light coagulation.
• Thermotherapy: Uses heat from a laser to destroy cancer cells and shrink the tumor.