Melanoma of the eye

Definition

Melanoma of the eye is cancer that occurs in various parts of the eye.

Alternative Names

Malignant melanoma - choroid; Malignant melanoma - eye; Eye tumor; Ocular melanoma

Causes, incidence, and risk factors

Melanoma is a very aggressive type of cancer that can spread rapidly.

Melanoma of the eye can affect several parts of the eye, including the:

• Choroid
• Ciliary body
• Conjunctiva
• Eyelid
• Iris
• Orbit

The choroid layer is the most likely location of melanoma in the eye.

The cancer may only be in the eye, or it may spread (metastasize) to another location in the body, most commonly the liver. Melanoma can also begin on the skin or other organs in the body and spread to the eye.

Melanoma is the most common type of eye tumor in adults. Even so, primary melanoma of the eye is rare.

Excessive exposure to sunlight is an important risk factor. The occurrence of melanoma has greatly increased in recent decades. Fair-skinned and blue-eyed people are most often affected.

Symptoms

• Bulging eyes
• Change in iris color
• Poor vision in one eye
• Red, painful eye
• Small defect on the iris or conjunctiva

In some cases, there may be no symptoms.

Signs and tests

An eye examination with an ophthalmoscope may reveal a single round or oval lump (tumor) in the eye.

Tests may include:

• Cranial CT scan to look for spread (metastasis) to the brain
• Eye ultrasound
• MRI of the head to look for metastasis to the brain
• Skin biopsy if there is an affected area on the skin

Treatment

Small melanomas may be treated with lasers, brachytherapy, or radiation therapy.

Surgical removal of the eye (enucleation) may be necessary.

Chemotherapy or biological therapy (interferon) are considered less effective therapies for melanoma involving the eye.

Support Groups

For additional resources, see cancer support group.

Expectations (prognosis)

The outcome for melanoma of the eye depends on the size of the cancer at the time of diagnosis. Most patients will survive at least 5 years from the time of diagnosis if the cancer has not spread outside the eye.

If the cancer has spread outside the eye, the chance of survival is much lower.

Complications

• Distortion or loss of vision
• Retinal detachment
• Spread of the tumor to other areas of the body

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of melanoma of the eye.

Prevention

The most important way to prevent eye melanoma is to avoid excessive exposure to sunlight, especially between 10 a.m. and 2 p.m., when the sun's rays are most intense. Wear sunglasses, and be sure they have ultraviolet protection.

A yearly eye exam is recommended.

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References

In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG, eds. Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 73.