About Intraocular (Eye) Melanoma

Overview

Intraocular (eye) melanoma is a type of cancer that occurs in the tissues of the eye. It specifically starts in the middle layer of the eye, known as the uvea or uveal tract. The uvea consists of three parts: the iris (colored area at the front of the eye), ciliary body (ring of tissue behind the iris), and choroid (layer of blood vessels that nourish the eye). Intraocular melanoma can affect any of these parts. It is a rare condition and may not cause early signs or symptoms. However, some possible symptoms include blurred vision, dark spots on the iris, floaters (spots drifting in your field of vision), or changes in pupil size or shape. Diagnosis is typically made through an eye exam with a dilated pupil, and further tests may be done to confirm the presence of intraocular melanoma. Treatment options depend on various factors and should be discussed with a healthcare professional.

Causes and Risk Factors

Intraocular (eye) melanoma, while rare, is the most common eye cancer for adults. It is caused by mutations (changes) in the DNA of eye cells that cause the cells to grow and multiple out of control. The exact reason this occurs is not fully understood, but there are certain risk factors that can increase a person's chances of developing this condition.

Non-modifiable risk factors are factors that cannot be changed or controlled. Non-modifiable risk factors for intraocular melanoma include:

Race: White people have a higher risk of developing intraocular melanoma than people of other races.
Lighter iris color: Having light-colored eyes, such as blue or green, is associated with an increased risk.
Age: The risk of eye melanoma increases as people get older, especially around age 70 years.
Certain inherited skin conditions: People with abnormal moles (dysplastic nevus syndrome) have a higher risk of developing intraocular melanoma.
Genetics: Certain inheritable genes that are passed from parent to child may increase risk.

Modifiable risk factors are factors that can be influenced or changed. There are no definitive modifiable risk factors for intraocular melanoma. Exposure to ultraviolet (UV) light from the sun or tanning beds possibly may increase risk; however, additional research is needed.

It's important to note that having these risk factors does not guarantee the development of intraocular melanoma. If you have concerns about your risk, it's best to consult with your healthcare professional.

Symptoms

Intraocular melanoma may not cause early signs or symptoms, but as the condition progresses or reaches a higher severity, the following symptoms may occur:

Early Symptoms:

Blurred vision or other changes in vision
Floaters (spots that drift in your field of vision) or flashes of light
A dark 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

Later Stage Symptoms:

Vision problems, such as partial loss of the field of sight
Growing dark spot on the colored part of the eye
Unusual change in pupil size or shape
Changes in how the eye moves
Eye bulging

It's important to note that these symptoms can also be caused by other conditions. If you experience any of these symptoms that do not go away, it's recommended to check with your healthcare provider for further evaluation and diagnosis.

Diagnosis

To diagnose intraocular melanoma, healthcare professionals may perform several examinations, tests, and procedures, including:

Ophthalmoscopy: An examination of the inside of the eye using a small magnifying lens and a light to check the retina and optic nerve.
Slit-lamp biomicroscopy: An examination of the inside of the eye using a strong beam of light and a microscope to check the retina, optic nerve, and other parts of the eye.
Gonioscopy: An examination of the front part of the eye to see if the area where fluid drains out of the eye is blocked.

Ultrasound exam of the eye: High-energy sound waves are bounced off the internal tissues of the eye to make echoes, helping evaluate any abnormalities.

Based upon initial findings and individual factors, additional examinations, tests, and procedures may be performed, such as:

CT scan or MRI scan: Further imaging tests to evaluate the extent of the tumor.
Biopsy: Rarely needed, but it may be recommended to confirm the diagnosis.
Liver ultrasound and liver blood tests: These tests are done routinely to monitor for spreading of the tumor throughout the body.

Blood chemistry studies: Checking blood samples to measure substances released by organs and tissues in the body.

Chest x-ray: An x-ray of organs and bones inside the chest to check if cancer has spread.

Remember, these are general descriptions. Your specific situation may require different tests. Consult with your healthcare professional for personalized advice.

Treatment Options

The goals of treatment for intraocular melanoma are to prevent the cancer from spreading (metastasis), preserve vision when possible, and reduce tumor burden and ocular morbidity. The specific treatment options for intraocular melanoma include:

Watchful waiting: This approach involves closely monitoring the condition without immediate treatment, especially for smaller tumors, to assess tumor growth and symptoms.
Surgery: Surgery may involve resection (removal of the tumor and surrounding tissue), enucleation (removal of the entire eye and part of the optic nerve), or exenteration (removal of the eye, eyelid, and surrounding structures).
Radiation therapy: Different types of radiation therapy, such as plaque radiation therapy, charged-particle external-beam radiation therapy, or proton beam therapy, may be used to destroy cancer cells.
Photocoagulation or thermotherapy: These therapies, sometimes called laser treatment, use light or heat to destroy cancer cells.

It's important to note that the choice of treatment depends on factors like tumor size, location, and overall health.