What is ocular melanoma?
There are many different types of cancer that can affect the eye, but ocular melanoma is the most common. Melanoma is a type of cancer that develops in the cells of the body that produce melanin — the pigment that gives your skin its colour. Your eyes also have melanin-producing cells and can develop melanoma. Ocular melanoma is also known as uveal melanoma, intraocular melanoma or eye melanoma.
Ocular (uveal) melanoma is rare with around 125-150 Australians diagnosed each year with this type of cancer. It is slightly more likely to be diagnosed in men, and can occur at any age but the risk increases as people get older.
Ocular melanoma symptoms
Ocular melanoma can be difficult to diagnose as it forms in the part of the eye that isn’t visible to you or others. It doesn’t typically cause any signs and symptoms and is usually detected by an optometrist during a routine eye test.
Symptoms that some people may experience include:
poor or blurred vision in one eye
loss of peripheral vision
brown or dark patches on the white of the eye
a dark spot on the iris
small specks, wavy lines or ‘floaters’ in your vision
flashes in your vision
a change in the shape of the pupil.
Causes of ocular melanoma
The cause of ocular melanoma is not known in most cases. However, there are several risk factors including:
having pale or fair skin
having a light eye colour
family history of melanoma
having a growth on or in the eye
certain skin conditions which causes abnormal moles to grow and this can increase your risk.
Diagnosis of ocular melanoma
If your doctor or optometrist thinks that you may have ocular melanoma, they will carry out certain tests.
If the results suggest that you may have ocular melanoma, your doctor will refer you to a specialist doctor called an ophthalmologist who specialises in ocular oncology. The ophthalmologist will carry out more tests that may include:
This is a test that allows your doctor to look at the inside of your eye to check for abnormalities. You may be asked to look into a large microscope that sits on a table. The doctor may put drops in your eye to widen (dilate) your pupil, allowing the doctor to look inside the eye so that they don’t need to perform a biopsy.
Colour fundus photography
In this procedure photographs of the back of your eye (fundus) will be taken and can help show what the tumour looks like before and after treatment. You will have eye drops to dilate your pupil.
An ultrasound uses soundwaves to create pictures of the inside of your eye and surrounding areas. A gel will be spread over your closed eyelid and a small device called a transducer will be moved over the area. The transducer sends out soundwaves that echo when they come across something dense, like a tumour or an organ.
If you need surgery, this test will be done first to show where the melanoma is. The lights in the room will be turned down and your doctor will shine a very bright light into your eye to check for abnormal areas.
Special machines are used to scan and create pictures of the inside of your body. You may have an injection of dye into your veins before the scan which makes the pictures clearer. During the scan you will lie on a table which moves in and out of the scanner. A CT scan takes about 10-30 minutes.
An MRI scan produces detailed cross-sectional pictures of your body and can show the extent of any tumours. You will lie on a table which slides into a large metal tube that is open at both ends. An MRI scan takes about 30-90 minutes.
In most cases, the ophthalmologist can make a diagnosis from what they can see when they examine your eye from photographs and ultrasound images. However, sometimes a biopsy is needed where some tissue is removed from the affected area to be examined under a microscope.
Treatment for ocular melanoma
Discussion with your doctor will help you decide on the best treatment for your cancer depending on the site of the cancer you have (choroid, ciliary body or iris); size of the cancer; how close the cancer is to other parts of the eye] whether or not the cancer has spread; your age, fitness and general health and your preferences.
The main factors in deciding on what treatment you will have are the location and size of the tumour and wanting to save the sight of your eye. Preserving how your eye looks is also important. Treatments may include surgery, radiation therapy, laser treatment (transpupillary thermotherapy), photodynamic therapy and immunotherapy.
Surgery for ocular melanoma may involve removing just the tumour, removing part of the eye, or removing the entire eye (enucleation) if it has been severely damaged by the tumour.
Radiation therapy (radiotherapy)
Radiation therapy (also known as radiotherapy) uses high energy rays to destroy cancer cells. It may be used for ocular melanoma:
- after surgery, to destroy any remaining cancer cells and stop the cancer coming back
- if the cancer can’t be removed with surgery
- instead of removing the eye (enucleation)
- if the cancer has spread to other parts of the body (e.g. palliative radiation to control symptoms or to manage pain).
Laser treatment (transpupillary thermotherapy) or photodynamic therapy
This treatment uses an infrared laser to heat and destroy cancer cells. It is sometimes combined with photodynamic therapy which uses a laser combined with a light-sensitive drug to destroy cancer cells.
Immunotherapy uses drugs to stimulate your own immune system to recognise and attack cancer cells. It has been very helpful in treating skin melanoma and has now shown benefit in treating ocular melanoma.
In some cases of advanced cancer, treatment will focus on managing any symptoms, such as pain, and improving your quality of life without trying to cure the disease. This is called palliative treatment.
Palliative care can be provided in the home, in a hospital, in a palliative care unit or hospice, or in a residential aged care facility. Services vary because palliative care is different in each state and territory.
Treatment TeamDepending on your treatment, your treatment team may consist of a number of different health professionals, such as:
- GP (General Practitioner)- looks after your general health and works with your specialists to coordinate treatment.
- Radiation oncologist- prescribes and coordinates radiation therapy treatment.
- Medical oncologist- prescribes and coordinates the course of chemotherapy.
- Cancer nurses- assist with treatment and provide information and support throughout your treatment.
- Other allied health professionals- such as social workers, pharmacists and counsellors.
- Ophthalmologist- Also known as an eye doctor or eye surgeon, ophthalmologists handle all medical aspects of eye care including treatment, surgery and prescriptions for glasses and contact lenses.
Screening for ocular melanoma
There is currently no national screening program for ocular melanoma available in Australia.
Preventing ocular melanoma
While the causes of ocular melanoma are not known in most cases, protecting yourself from exposure to UV radiation can reduce your risk.
Prognosis for ocular melanoma
It is not possible for a doctor to predict the exact course of a disease as it will depend on the person's individual circumstances. However, your doctor may give you a prognosis, the likely outcome of your disease, based on the type of cancer you have, your test results, the rate of tumour growth, as well as your age, fitness and medical history.
Understanding Ocular Melanoma. Cancer Council Australia © 2021. Last medical review of the source fact sheet: February 2021.
Australian Institute of Health and Welfare (AIHW). Cancer in Australia 2019. Cancer series no.119. Cat. no. CAN 123. AIHW, Canberra, 2019.
This web-based resource was made possible by the Cancer Australia Supporting people with cancer Grant initiative, funded by the Australian Government.