Intraocular Melanoma

About Intraocular Melanoma

Intraocular or uveal melanoma forms when melanocytes, the cells that make the pigment (melanin) in skin, hair, and eyes, develop in certain eye parts, and become malignant. These lesions can arise spontaneously, come from a preexisting nevus, or from a underlying condition that increases risk of developing melanoma of the eye.

Risk Factors

Although intraocular melanoma is rare, it is still the most common primary eye cancer in adults. The disease is usually diagnosed among fair skinned people, with a peak age of diagnosis in the sixth decade of life.  There are no known environmental risk factors for uveal melanoma which is different from skin melanoma which can be increased by excessive sun light.

Symptoms

Uveal melanoma may have no early signs or symptoms, and it is sometimes found during an eye exam when ophthalmologists dilate the pupil to examine the inside of the eye. As the tumor grows, it may cause symptoms including:

• Blurred vision or other change in vision.
• Floaters (spots that drift in your field of vision) or flashes of light.
• A dark or lighter spot on the iris.
• A change in the size or shape of the pupil.
• A change in the position of the eyeball in the eye socket.

Diagnosis

Columbia ophthalmologists use several tests and procedures to diagnose uveal melanoma. To perform most of these tests, they dilate or enlarge the pupil, enabling them to examine the inside of the eye. They may take pictures during these exams to help them track changes in the size of the tumor over time. These tests may include:

• Ophthalmoscopy – An exam using a small magnifying lens and a light to look at the inside of the eye.
• Slit-lamp Biomicroscopy – An exam using a strong beam of light and a microscope to check the front of the eye, retina, optic nerve, and other parts of the eye
• Gonioscopy – An exam of the front part of the eye between the cornea and iris
• Ultrasound – An imaging test in which high-energy sound waves (ultrasound) are bounced off the internal tissues of the eye to create an image of the inside of the eye
• High-Resolution Ultrasound Biomicroscopy – A higher-resolution ultrasound exam that creates a more detailed image than is possible with normal ultrasound
• Transillumination of the globe and iris – An exam of the iris, cornea, lens, and ciliary body with a light placed on either the upper or lower lid
• Fluorescein Angiography – A examination of the blood vessels and blood flow inside the eye
• Indocyanine Green Angiography – A examination of the blood vessels and blood flow inside the eye and the choroid layer of the eye
• Optical Coherence Tomography – An imaging test that uses light waves to visualize microscopic layers in the eye including the retina and choroid.

Treatments We Offer

Treatment includes one or more of the following therapies:

• Observation: If a lesion is suspicious for a melanoma and shows no signs of growing or does not look like a classic melanoma ophthalmologists may closely monitor, but not treat, a patient until signs or symptoms appear, or the lesion grows. Careful examination of the lesion will be performed with pictures, and other diagnostic tools to track the suspicious lesion over time.
• Radiation Therapy – Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Ophthalmologists choose the most effective mode of delivering radiation therapy based on the type and stage of each patient’s tumor. Radiation may be delivered multiple ways and the decisions to use a type of radiation delivery is based on and customized to the patient and lesion being treated.
• Laser Therapy-   A laser is a concentrated type of light used to selectively deliver energy to a specific area. This energy can be used to precisely treat tumors in the eye. Different types of lasers can be used for specific tumors.  Lasers can be used independently or in combination with other treatments.
• Surgery: The following types of surgery may be used:
  • Resection – Surgery to remove the tumor and a small amount of healthy tissue around it.
  • Enucleation – Surgery to remove the eye and part of the optic nerve.
  • Exenteration – Surgery to remove the eye and eyelid, muscles, nerves, and fat in the eye socket.  

Why Choose Columbia?

Columbia ophthalmologists use a multidisciplinary approach working with eye cancer experts and oculoplastic surgeons, oncologists, pathologists, neurologists, researchers, and a team of experts to ensure you have a coordinated treatment plan to become cancer-free and resume a normal life.