Ocular Melanoma

Ocular Melanoma (Cancer of the Eye)

Definition

Ocular melanoma, a rare cancer, is a disease in which cancer (malignant) cells are found in the part of the eye called the uvea. The uvea contains cells called melanocytes. When these cells become cancerous, the cancer is called a melanoma. The uvea includes the iris (the colored part of the eye), the ciliary body (a muscle in the eye), and the choroid (a layer of tissue in the back of the eye). The iris opens and closes to change the amount of light entering the eye. The ciliary body changes the shape of the lens inside the eye so it can focus. The choroid layer is next to the retina, the part of the eye that makes a picture. If there is melanoma that starts in the iris, it may look like a dark spot on the iris. If melanoma is in the ciliary body or the choroid, a person may have blurry vision or may have no symptoms, and the cancer may grow before it is noticed. Ocular melanoma is usually found during a routine eye examination, when a doctor looks inside the eye with special lights and instruments.

The chance of recovery (prognosis) depends on the size and cell type of the cancer, where the cancer is in the eye, and whether the cancer has spread.

Age and sun exposure may increase the risk of developing intraocular melanoma.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for intraocular melanoma include the following:

  • Older age
  • Being white
  • Having a fair complexion (light skin) or green or blue eyes.
  • Being able to tan

Possible signs of intraocular melanoma include a dark spot on the iris or blurred vision.

Intraocular melanoma may not cause any early symptoms. It is sometimes found during a routine eye exam when the doctor dilates the pupil and looks into the eye. The following symptoms may be caused by intraocular melanoma or by other conditions. A doctor should be consulted if any of these problems occur:

  • A dark spot on the iris
  • Blurred vision
  • A change in the shape of the pupil
  • A change in vision

Glaucoma may develop if the tumor causes the retina to separate from the eye. If this happens, there may be no symptoms, or symptoms may include the following:

  • Eye pain
  • Blurred vision
  • Eye redness
  • Nausea


Ocular melanoma Locations:

Ocular melanoma can occur in a variety of ocular tissue.


Iris

Ocular melanomas of the iris occur in the front colored part of the eye. Iris melanomas usually grow slowly and do not usually spread to other parts of the body.

Ciliary body/choroid (small size)

Ocular melanomas of the ciliary body and/or choroid occur in the back part of the eye. They are grouped by the size of the tumor. Small size ciliary body or choroidal melanoma is 2 to 3 millimeters or less thick.

Ciliary body/choroid (medium/large size)

Ocular melanomas of the ciliary body and/or choroid occur in the back part of the eye. They are grouped by the size of the tumor. Medium/large size ciliary body or choroid melanoma is more than 2 to 3 millimeters thick.

Extraocular extension

The melanoma has spread outside the eye by extending through the wall of the eye, the sclera.

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated.

Metastatic

Metastatic melanoma means that the tumor has spread far from the eye, usually to the liver.


Symptoms

Most melanomas of the iris, ciliary or choroid are initially completely asymptomatic. As the tumor enlarges, the tumor may cause distortion of the pupil (iris melanoma), blurred vision (ciliary body melanoma) or markedly decreased visual acuity from a secondary retinal detachment caused by a choroidal melanoma. Most melanomas are detected by routine ophthalmic examination which should include dilation of the pupil and detailed examination of the posterior aspect of the eye to detect choroidal melanomas. Like most early cancers, an early melanoma is usually a silent cancer.

Determining that the Lesion is a Malignant Melanoma

One of the difficulties in diagnosing small melanomas is that it can be very difficult to differentiate a small malignant melanoma from a benign pigmented tumor, such as an iris or choroidal nevus. At present there is no definitive test that clearly differentiates a nevus from a small malignant melanoma. Even with special biopsy techniques, such as fine needle aspiration of the lesion, it can be very difficult to differentiate a benign nevus from a malignant melanoma. A distinguishing feature of a small malignant melanoma from a nevus is that the malignant melanoma progressively grows and enlarges. Thus, small lesions may initially be observed to determine if the lesion remains static or shows evidence of progressive growth.

The symptoms described above may not necessarily mean that you have ocular melanoma. However, if you experience one or more of these symptoms, contact your eye doctor for a complete exam.

Treatment

Once a definite diagnosis of malignant melanoma is made, possible therapies depend on the location and size of the tumor. Metastatic melanoma can be difficult to treat. In this situation, the ocular melanoma has spread far from the eye and typically has spread to the liver.

Surgery

Small melanomas of the iris or ciliary body can sometimes be successfully treated with surgery. An iridectomy refers to removal of part of the iris where the tumor is present. An iridocyclectomy refers to removal of part of the iris as well as the adjacent ciliary body where the tumor is present. With very large tumors, the only possible option is removal of the eye, which is called enucleation. Following removal of the eye, an artificial eye is placed in the socket. With today's techniques, it can be extremely difficult to differentiate the artificial eye from the adjacent normal eye.


Reference

http://www.kellogg.umich.edu/patientcare/conditions/ocular.melanoma.html

After Enucleation takes place and a prosthesis is needed, you need to ensure for your coperation with an Ocularist.

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