How Ocular Melanoma Is Treated

Treatments for ocular (eye) melanoma depend a lot on the size and stage of your cancer and how fast the cancer is growing. Some cancers grow very slowly and rarely spread. In these cases, your doctor may choose to monitor the cancer closely without performing any invasive procedures.

The focus of treatment is on preserving vision and may include surgery, radiation, or laser therapy. Read on to learn more about ocular melanoma treatments.

Patient undergoing laser eye surgery

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Types of Ocular Melanoma

Most ocular melanomas form in the area of the eye called the uvea, which includes the iris, ciliary body, and choroid. This is called uveal melanoma. While it is the most common type of cancer of the eye, it is still rare, with an incidence of 5.1 cases per 1 million people per year. The area of the eye where the cancer starts may influence the type of treatment you may have.

Observation

Your doctor may recommend holding off on treatment and observing the cancer if the ocular melanoma is small or slow-growing and/or if treating the cancer would cause more discomfort than the disease itself.

You would be monitored closely, and any active treatment would begin if the tumor started showing signs of becoming more aggressive or spreading. This approach may be called observation or watchful waiting. Talk with the doctor about how often your eye should be checked.

Surgeries and Specialist-Driven Procedures

If caught before spreading outside the eye, doctors can successfully treat most ocular melanomas with surgery, specialist procedures, or a combination of treatments. The smaller the tumor, the less likely surgery will be needed unless the eye is badly damaged or vision is lost.

Radiation Therapy

Radiation therapy uses high-energy X-rays to kill cancer cells. It is a common treatment for eye melanoma. Radiation therapy can often save some vision in the eye. Getting treatment is much like getting an X-ray, but the dose of radiation is much higher.

There are two main types of radiation therapy for eye melanoma:

  • External radiation therapy, which points beams of radiation at the tumor from outside the body. Special techniques such as proton beam radiation target the tumor. This minimizes damage to nearby eye and brain tissues.
  • Internal radiation therapy, which implants seeds of radiation inside the eye, near the tumor. Providers call this technique radioactive plaque therapy or brachytherapy. The seeds are inside a metal plaque (disc) to protect other parts of the eye.

The main concern with radiation therapy is damage to parts of the eye, leading to problems such as blurry vision, dry eye, cataracts, retinal detachment, glaucoma, loss of eyelashes, problems with tear ducts, or bleeding into the eye.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. During the surgery, the ophthalmologist (specialist eye doctor) will remove parts or all of the affected eye depending on the size and spread of the tumor.

The operations used to treat people with eye melanoma include:

  • Iridectomy: Removal of part of the iris
  • Iridotrabeculectomy: Removal of part of the iris, plus a small piece of the outer part of the eyeball
  • Iridocyclectomy: Removal of a portion of the iris and the ciliary body
  • Enucleation: Removal of the eyeball

The potential side effects of eye surgery are similar to that of any surgery, including a risk of infection, problems from the general anesthesia (the medication used during surgery), and pain.

Removal of the eye may be necessary in some cases when other treatment methods are not suitable. During the eye removal operation, an orbital implant is usually put in to take the place of the eyeball. Within a few weeks after surgery, patients visit an ocularist (a specialist in eye prostheses) to be fitted with an artificial eye, a thin shell that fits over the orbital implant and under the eyelids. The artificial eye will match the size and color of the remaining eye.

Laser Therapy

Rarely, laser therapy is used to treat very small ocular melanomas, or after radiotherapy to reduce the risk of the cancer coming back. This procedure uses heat in the form of a laser to shrink a smaller tumor. It may also be called thermotherapy or transpupillary thermotherapy (TTT).

TTT caries potential side effects like bleeding, retinal detachment, and blockage of blood vessels in the eye.

Recurrent Ocular Melanomas

Unfortunately, in about half of all patients, ocular melanoma will come back at some point after treatment. Cancer that comes back after treatment is called recurrent. Recurrence can be local (in or near the same place it started) or distant (spread to organs such as the lungs or liver). Often the treatment plan will include the treatments described above, such as surgery or radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

Prescriptions

In recent years, researchers have developed newer types of drugs to treat advanced melanomas. Several of these drugs are now used to treat melanomas of the skin, but it’s not yet clear if they will be as helpful in treating ocular melanomas.

Clinical trials are ongoing to find out if immunotherapy drugs, which stimulate the body’s own immune system to recognize and attack cancer cells more effectively, will work to treat ocular melanoma.

Home Remedies and Lifestyle

If you have been diagnosed with cancer, your doctor will offer some tips to improve your health and well-being to complement your treatment. These may include:

  • Using relaxation techniques, such as guided imagery and meditation
  • Getting enough sleep
  • Engaging in regular exercise
  • Eating a healthy diet, which can help manage cancer side effects, recovery, and overall health

Over-the-Counter (OTC) Therapies

Your medical team may recommend various over-the-counter products for the relief of symptoms or side effects of your treatment, such as OTC pain relievers.

It is always important that you report any OTC medications, supplements, and herbal remedies that you use to your healthcare team. There is a risk of interactions with your prescription medications and other forms of treatment (such as bleeding if aspirin is taken before surgery).

Some products will also not be advised during radiation therapy as they may increase side effects.

Complementary and Alternative Medicine (CAM)

There is little evidence to suggest that complementary and alternative treatments can cure cancer or slow its growth, but there is positive evidence that some mind-body therapies may help people cope with the symptoms of cancer and cancer treatments.

These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage.

Be sure to talk to your cancer care team about any new treatment you are thinking about using. 

A Word From Verywell

The main factors in deciding on treatment for eye melanoma include the location and size of the cancer, as well as the likelihood of saving vision in the eye. Your doctor will work with you to determine the optimal treatment plan for a positive outcome.

If eye removal is required, talk with your doctor about a prosthesis as soon as possible. Also, ask about support services that may be available to you to help adjust physically and emotionally to the loss of an eye.

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6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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