Eye Melanoma – Diagnosis and Treatment
Diagnosis
Visual Check of the Eye
An eye doctor often begins by closely examining the outside and inside of the eye. They look for unusual swelling or blood vessels, which can be warning signs of eye cancer.
Special tools help them see deep into the eye. Binocular indirect ophthalmoscopy and slit-lamp biomicroscopy let doctors examine the retina, iris, ciliary body, and areas where cancer can develop.
| Imaging Test | What It Detects |
|---|---|
| Fundus photography | Tumors, dark patches |
| Eye ultrasound | Tumor thickness, position |
| Eye angiography | Abnormal blood vessels, tumor spread |
| Optical coherence tomography (OCT) | Layers of retina, tissue changes |
| Biopsy | Cancer cell type, details |
| Blood work/Imaging (CT, MRI, PET) | Spread to other organs |
Taking Pictures of the Back of the Eye
Doctors take color images of the inside surface of the eye—called the fundus—to reveal growths or dark patches that suggest melanoma. Fundus photography helps monitor changes over time.
They may also use fundus autofluorescence, another method for checking for intraocular melanoma or changes in the retina.
Uses of Fundus Images:
- Track tumor size.
- Monitor growth or shrinkage.
- Spot early signs of eye cancer.
Using Sound Waves to See Inside the Eye
Doctors use an ocular ultrasound to check the size and position of a tumor inside the eye.
A device that sends sound waves is placed over the eyelid or on the eye itself. The echoes produce images that help determine if it might be uveal or choroidal melanoma.
Benefits of Eye Ultrasound:
- Measures tumor thickness
- Sees the tumor behind the colored part of the eye
- Distinguishes types of cancer from other growths
Imaging the Eye’s Blood Vessels
Doctors inject a colored liquid (dye) into a person’s vein for eye blood vessel imaging. Special cameras track the dye as it moves through the tiny blood vessels in the eye.
Fluorescein angiography and indocyanine green angiography are the common types. These tests show if abnormal blood vessels are linked with the tumor, which can help confirm melanoma of the choroid or other eye cancers.
Light-Based Scans of the Eye’s Layers
Optical coherence tomography (OCT) uses special light waves to give cross-sectional pictures of the retina and the uvea.
OCT can identify tumors, swelling, or changes in tissue caused by ocular melanoma, helping distinguish between types of intraocular growths.
Collecting Tissue Samples
Sometimes, doctors remove a tiny amount of tissue from the eye, called a tissue sample or biopsy. Most cases of melanoma in the eye do not require this test to confirm the diagnosis.
However, if needed, a small needle may remove cells for close study in the lab. This confirms the type of cancer and helps plan treatment, especially in more complex or unclear cases.
Note: Doctors might perform a biopsy during treatment to learn more about the cancer’s features.
Checking If the Cancer Has Spread
Doctors use tests to see if melanoma has affected areas outside the eye, such as the liver or lungs.
Tests for Spread May Include:
- Blood work and liver function checks
- Chest x-ray
- Ultrasound of other organs
- CT scan
- MRI
- PET scan
These steps help doctors find out how advanced the cancer is, decide on the best treatment, and monitor for spread over time.
Treatment
Observation for Small Eye Melanomas
For very small eye melanomas, doctors may choose to monitor these tumors closely over time. This approach involves regular eye exams and scans to check for changes in tumor size or shape.
If no growth or symptoms develop, doctors delay active intervention until necessary.
Using Radiation to Treat Eye Melanoma
Doctors commonly use radiation therapy for small to medium-sized eye melanomas. There are two main ways to deliver this treatment:
- Brachytherapy: Doctors place small radioactive seeds on a tiny disc, then temporarily attach it to the outside of the eyeball near the melanoma. After a few days, they remove the disc.
- External Beam Radiation: They aim carefully targeted radiation beams, such as proton beams, at the tumor from outside the body over several days.
Radiation can help shrink tumors and may preserve more of the patient’s vision compared to some surgical options.
Treating with Laser Procedures
Doctors use laser treatments with focused light to destroy or damage cancer cells. Thermotherapy, which uses infrared laser light, is sometimes combined with radiation.
Laser options may work for certain cases, depending on the tumor’s size and location.
Photodynamic Therapy to Manage Eye Melanoma
In photodynamic therapy, doctors use a medicine called a photosensitizer that becomes active when exposed to a light source, often a laser. First, they inject the medicine or give it as eye drops.
Then, they aim a special light at the tumor to activate the drug. This treatment works best for smaller tumors and can damage cancer cells with minimal harm to surrounding eye tissue.
Surgical Approaches for Eye Melanoma
Doctors may recommend surgery if other treatments are not suitable or if the tumor is large.
Types of surgical procedures include:
| Procedure Name | Description |
|---|---|
| Tumor Excision | Doctors remove the melanoma along with a small margin of healthy tissue. |
| Enucleation | They remove the entire eyeball, usually if the cancer is large or if vision cannot be saved. |
After enucleation, a surgeon may place an implant in the socket, connecting eye muscles to the implant so it can move. Once healed, a custom prosthetic eye matching the remaining eye’s appearance is fitted into place.
Targeted Drug Therapies for Eye Melanoma
Targeted therapy uses drugs that act on specific substances involved in cancer cell growth and division. Unlike treatments that affect all fast-growing cells, targeted medicines block signals that cancer cells use to survive or multiply.
Doctors often reserve this therapy for advanced cases, such as when the melanoma spreads outside the eye or if typical treatments like surgery are not possible.
Examples of Targeted Therapy Approaches:
- Blocking proteins responsible for tumor growth
- Interfering with cancer cell reproduction
Doctors tailor these treatments to the characteristics of the cancer, which may help limit damage to healthy tissues.
Immunotherapy Medications for Eye Melanoma
Immunotherapy helps the body’s immune system find and destroy cancer cells. Since cancer cells often hide from immune defenses, these medicines boost the immune system’s ability to recognize and attack the tumor.
Immunotherapy provides another option when the eye melanoma has spread to distant parts of the body (metastasized) or if surgery is not recommended.
Common Features of Immunotherapy:
- Enhances the body’s natural defenses.
- Targets cancer cells that evade other treatments.
- Can be combined with other therapies for advanced disease.
Doctors design each treatment plan based on factors like the tumor’s size, location, whether it has spread, overall health, and the patient’s preferences.
A team that may include ophthalmologists, radiation oncologists, and other cancer specialists usually guides care for eye melanoma.
Managing Adjustment and Support
Handling Changes in Sight
Losing vision in one eye after cancer treatment can affect daily life, especially how someone judges distance and notices things to the side.
Most people can still perform usual activities, but adapting often takes time and patience. It might be harder to spot objects or movement on the side that cannot see.
Ways to manage vision loss include:
- Practicing new ways to move safely.
- Using special techniques to judge distances.
- Asking an occupational therapist for guidance.
Support groups offer advice and a place to talk about these changes. Healthcare providers can suggest resources or recommend professionals to help make adjustments easier.
Getting Ready for Your Visit
Steps You Can Take Before the Visit
To make the most of your appointment, patients can take several steps ahead of time. Being prepared helps ensure that important details aren’t missed and that they get the answers they need.
- Check for Special Instructions: When making the appointment, ask if there is anything specific to do before the visit, like not eating before certain tests or bringing paperwork.
- List Symptoms Clearly: Write down all symptoms, including minor ones, even if they don’t seem connected to the main issue.
- Record Key Life Details: Keep track of stressful events, recent changes, or family health history that could be relevant.
- Bring a Medication List: List all medications, vitamins, and supplements being taken. This information is important for both ophthalmologists and ophthalmic oncologists to prevent any medicine conflicts.
- Invite a Support Person: Bringing a trusted family member or friend can help with remembering details from the conversation.
- Prepare Questions in Advance: Write down any questions. This helps patients use their limited time well and remember to ask critical questions.
Sample Questions to Ask:
| Question Type | Example Questions |
|---|---|
| Diagnosis | Do I have eye melanoma? Where is it located in my eye? |
| Test Results | What tests are needed? Has it spread outside the eye? |
| Treatment | What treatments are available? What side effects might happen? |
| Overall Management | Can the treatment cure the melanoma? How soon must treatment start? |
| Everyday Impact | How will treatment affect my vision or daily activities? |
| Other Concerns | How should I handle my other health conditions? Should I see more specialists? |
| Information | Can I get brochures or recommended websites for more information? |
Putting the most important questions at the top of the list helps ensure time during the appointment is spent wisely.
Questions Your Eye Doctor Might Ask
During the appointment, healthcare professionals such as ophthalmologists or ophthalmic oncologists will likely ask questions to better understand your situation.
Some examples include:
- When did symptoms first begin?
- Are the symptoms present all the time, or do they come and go?
- Have you noticed any changes in your vision or eye appearance?
- Have you experienced any other recent health changes?
Doctors use this information to decide what tests to order or which treatments to recommend. Bring notes to help you remember your medical history and answer questions more completely.
Tip: Answer all questions as accurately as possible to help your eye specialist or cancer doctor give the best care.
If you prepare details about your past health, medicine use, and symptoms, you make the appointment more useful for both yourself and your doctor. This preparation helps specialists like ophthalmologists and ophthalmic oncologists choose the best treatment approach.
