What Is Ocular Melanoma?

Ocular melanoma is eye cancer that arises in cells known as melanocytes, which give color to body parts such as your lips, skin, and eyes. It may not have symptoms unless it spreads or is in an area of the eye where it affects vision.

About 2,500 adults in the United States are diagnosed with ocular melanoma each year. Ocular melanoma can spread silently and may move to other parts of the body, where, much like melanoma of the skin, it may be life-threatening.

This article highlights the types of ocular melanoma, its symptoms, its possible causes, and the diagnosis and treatment process.

Types of Ocular Melanoma

Not all ocular melanoma is the same. It can arise in different areas of the eye, including the lid, the globe itself, or even the clear covering of the eye known as the conjunctiva. Cases of melanoma of the lid or of the conjunctiva tend to be rare.

Among adults, uveal melanoma, which starts in the middle layer of the wall of the eye, is the most common type of ocular melanoma. If melanoma starts in the part of the uvea known as the choroid, which contains some of the blood supply for the eye, it is called choroidal melanoma.

Other parts of the uvea include the colored iris and the ciliary body, which is just behind the iris and works to focus the clear lens by altering its shape. If the cancer involves the the iris, it is often found early since it can be easily seen. It also tends not to grow rapidly and rarely is detected outside of the eye.

Ocular Melanoma Symptoms

Not everybody gets symptoms with ocular melanoma. Symptoms develop only if the cancer migrates into certain parts of the eye or if it grows. It helps to be aware of certain signs, including:

• Experiencing visual blurriness or sudden vision loss
• Noticing floaters resembling strands or cobwebs drifting across your vision or quick light flashes
• Losing sight in some portions of your visual field but not in others
• Noticing that the iris, the colored portion of the eye, contains a dark spot
• Finding that the pupil, the black circle at the center of the eye, looks different and has changed shape or size
• Feeling as if your eye is moving oddly or looks as if it's bulging

Keep in mind that just having some of these symptoms does not necessarily mean you have ocular melanoma. Still, it's important to rule it out promptly.

Causes

Unfortunately, there is no clear-cut reason why ocular melanoma develops. Still, ocular melanoma has been associated with certain factors that may put you at greater risk for developing it.

Ocular melanoma is likely related to errors in the DNA that develop in the pigmented cells of the eye. Factors that have been shown to play a role include:

• Having very light-colored skin
• Having light-colored blue or green eyes
• Having spent time in tanning salons
• Being somewhat older
• Having abnormal moles (dysplastic nevi) that tend to run in your family from conditions, such as dysplastic nevus syndrome
• Having a freckle or mole on the surface of the eye
• Having unusual eyelid pigmentation or an increase of this in the uvea

White people are more often diagnosed with ocular melanoma than Black people.

Diagnosis

If ocular melanoma is suspected, you will require a full eye exam. To help diagnose this condition an ophthalmologist (eye doctor) will perform the following exams:

• Your ophthalmologist will widen (dilate) your pupil and examine the structures of your eye with an ophthalmoscope.
• An ultrasound, which uses sound waves to construct an image of the inside of your eye, can help an ophthalmologist determine where the tumor is and how large it is.
• Fluorescein angiography, which involves injecting dye into your bloodstream and then detecting the dye with the aid of a special camera, can locate the tumor.
• A needle biopsy may be performed, where tumor cells are removed and analyzed in the lab to determine if they are cancerous.

Treatment

Determining what treatment is needed will depend on a variety of factors, including how advanced the tumor is when you are diagnosed. Some treatment options for ocular melanoma include the following:

• A wait-and-see approach may be taken if the tumor is very small. Some tumors can be extremely slow-growing. While a tumor needs to be vigilantly monitored, it may be quite a while before any progression is seen.
• Brachytherapy, in which radioactive seeds are placed on a plaque and temporarily positioned in the proximity of the tumor, allows the radiation to kill cancer cells.
• External beam radiation may be used. Tumor cells are killed by aiming radioactive beams from a machine at the tumor.
• Laser therapy relies on heat from a narrow beam of coherent light (waves of same frequency and phase) to destroy cancer cells.
• Surgery to remove the tumor may be performed if the tumor is small enough and you continue to have some vision.
• The eye may be removed with what's known as enucleation if the tumor is too large or you have lost vision in the eye. It is then possible to replace this with an artificial eye, which does not see but that matches the other one cosmetically.

Prognosis

How you ultimately do with ocular melanoma will depend not only on exactly where in the eye the tumor is located, but also on what the size of it may be at the time and whether the cancer has spread elsewhere.

For eye melanoma in general, the five-year survival rate is at 80%. If detected early, it is as high as 85%. Even in cases in which melanoma has spread to surrounding lymph nodes, the five-year survival rate remains at 73%.

For the 2% to 3% of cases that are diagnosed when there has already been spread to more distant parts of the body, the survival rate is 13%.

The area where the tumor starts plays a role in outcome. Tumors in the iris do not tend to spread and people who have a tumor in this location have a five-year survival rate of 95%. For choroidal melanoma (located in the middle of the wall of the eye) the five-year survival rate ranges from 84% for a small tumor to 47% for a very large one.

Coping

Learning that you have eye cancer can be a shock and can come with a wide range of emotions as you worry about your sight and your overall health. You may find yourself feeling everything from numb to being fearful, angry, or even guilty.

To better understand how a treatment affects people with ocular melanoma, as well as how to come to terms with the diagnosis, consider reaching out to others for support. This may involve speaking with a counselor one-on-one or perhaps talking with others who have had this diagnosis and who can help you to address what you may be feeling.

Summary

Ocular melanoma comes from melanocytes that give color to the lining of your eyes. It can occur in various parts of the eye such as the lid, the choroid, the iris, or the ciliary body. Treatment often involves radiation aimed at destroying the tumor or surgery to remove it.

Prognosis with ocular melanoma depends on where it is located and when it is detected. The sooner this is treated the better.

A Word From Verywell

While dealing with ocular melanoma can be challenging, your care team will help you to decide the best approach for preserving your health and your vision. This is a condition that already has many treatment options and more is being learned about it every day, which can only help improve outcomes.