Eye Cancer and Ocular Melanoma: What You Need to Know

Medically Reviewed By: Rizwan Haq, MD, PhD

Eye cancer is caused by uncontrollable cell growth in the eye. While an eye cancer diagnosis can be overwhelming, there are treatment options. An oncologist can discuss these options with you and work with you to determine your best care plan.

According to the American Cancer Society, eye cancer can form in the three major parts of the eye:

  • The eyeball: the globe that features three main layers (the sclera, the uvea, and the retina)
  • The orbit: the tissue surrounding the eye
  • The adnexal: structures like the eyelids and tear glands

The most common type of eye cancer is called ocular melanoma.

What is ocular melanoma?

Ocular melanoma, also known as uveal or choroidal melanoma, is a rare disease, but is also the most common eye cancer found in adults.

It is much less common than skin melanoma and the two diseases do not share a genetic makeup; however, both melanomas are produced from the same pigment-making cells in the body, which are called melanocytes.

Usually, when the melanoma develops in the eye, it is in the uvea, but in rare instances, it can develop in the conjunctiva.

What causes ocular melanoma?

It is unclear what causes ocular melanoma, but individuals with fair skin that burns easily are at a higher risk. However, there is no evidence that ocular melanoma is related to sun exposure.

Rizwan Haq, MD, PhD, director of the Ocular Melanoma Center at Dana-Farber/Brigham and Women’s Cancer Center.

What are the types of ocular melanoma?

Uveal melanomas

Ocular melanoma is often referred to as uveal melanoma because it develops on the eye’s uveal tract, which is made up of the iris, ciliary body, and choroid. The uvea has three main parts:

  • The iris: the colored part of the eye is where light enters the eyeball
  • The choroid: a thin layer lining the eyeball and provides blood to the retina and the front of the eye
  • The ciliary body: contains the muscles inside the eye that helps the eye focus on near and far objects

Most of intraocular melanoma (9 out of 10 cases) develop in the choroid or ciliary body. Most other ocular melanomas start in the iris, which tend to be slow-growing and rarely spread to other parts of the body. Uveal melanomas can spread through the blood to the liver.

Conjunctival melanomas

The conjunctiva is a thin covering over the sclera (the white part of the outside of the eyeball). Though these melanomas tend to be very rare, they are more aggressive and can grow into nearby areas. They can also spread to distant organs like the lungs, liver or brain, which can make the cancer life-threatening.

Signs and symptoms of ocular melanoma

Often, there are no unique symptoms of ocular melanoma. However, one may experience symptoms including:

  • Blurry vision
  • Slight eye soreness
  • Seeing flashing lights or shadows
  • Misting of eye lens

Often, people do not experience symptoms. The cancer is often diagnosed during a routine eye exam.

How is ocular melanoma treated?

Patients diagnosed with ocular melanoma are often initially treated with surgery and/or radiation. Surgery is determined by the location and size of the tumor, if it has spread, and the patient’s general health. Surgery options include removing the melanoma of the ciliary body or choroid to the removal of the eyeball.

Radiation therapy can be used as an initial treatment for ocular melanoma.

Ocular melanoma metastasizes (spreads) in nearly 50% of patients with ocular melanoma. In these cases, the disease tends to spread to the liver.

Treatments for patients with metastatic disease can involve clinical trials, liver-directed therapies, and interventional radiology, which includes the use of CT scans, X-rays, and MRI therapies directed to liver metastasis.

About the Medical Reviewer

Rizwan Haq, MD, PhD

Dr. Haq is a graduate of the University of Toronto, where he completed his B.Sc. (Hon), and MD/PhD. His PhD was at the Ontario Cancer Institute/Princess Margaret Hospital in the laboratory of Dr Brent Zanke. He completed his clinical training in internal medicine at The Johns Hopkins Hospital in Baltimore, followed by medical oncology training at Dana-Farber Cancer Institute and Massachusetts General Hospital. He joined the laboratory of Dr David E. Fisher, where he conducted translational work in the melanoma; and was an attending oncologist at Massachusetts General Hospital.

He was recruited back to Dana-Farber Cancer Institute in 2014. His research focuses on resistance to melanoma therapies, including targeted agents and immunotherapies. He has been a contributing author of numerous high profile publications, including those published in Cancer CellNatureProceedings of the National Academy of Sciences USA. At Dana-Farber Cancer Institute, Dr. Haq devotes part of his time to developing the next generation of melanoma therapeutics and translating them to innovative investigator-initiated clinical trials. His clinical practice is dedicated to patients with melanoma. 

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