Uveal melanoma (patient information)
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What are the symptoms of Uveal melanoma?
Intraocular melanoma may not cause early signs or symptoms. It is sometimes found during a regular eye exam when the doctor dilates the pupil and looks into the eye. Signs and symptoms may be caused by intraocular melanoma or by other conditions.
What causes Uveal melanoma ?
Diagnosis
- Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Eye exam with dilated pupil: An exam of the eye in which the pupil is dilated (enlarged) with medicated eye drops to allow the doctor to look through the lens and pupil to the retina. The inside of the eye, including the retina and the optic nerve, is checked. Pictures may be taken over time to keep track of changes in the size of the tumor. There are several types of eye exams:
- Ophthalmoscopy : An exam of the inside of the back of the eye to check the retina and optic nerve using a small magnifying lens and a light.
- Slit-lamp biomicroscopy : An exam of the inside of the eye to check the retina, optic nerve, and other parts of the eye using a strong beam of light and amicroscope.
- Gonioscopy : An exam of the front part of the eye between the cornea and iris. A special instrument is used to see if the area where fluid drains out of the eye is blocked.
- Ultrasound exam of the eye: A procedure in which high-energy sound waves (ultrasound) are bounced off the internal tissues of the eye to make echoes. Eye drops are used to numb the eye and a small probe that sends and receives sound waves is placed gently on the surface of the eye. The echoes make a picture of the inside of the eye and the distance from the cornea to the retina is measured. The picture, called asonogram, shows on the screen of the ultrasound monitor.
- High-resolution ultrasound biomicroscopy : A procedure in which high-energy sound waves (ultrasound) are bounced off the internal tissues of the eye to make echoes. Eye drops are used to numb the eye and a small probe that sends and receives sound waves is placed gently on the surface of the eye. The echoes make a more detailed picture of the inside of the eye than a regular ultrasound. The tumor is checked for its size, shape, and thickness, and for signs that the tumor has spread to nearby tissue.
- Transillumination of the globe and iris: An exam of the iris, cornea, lens, and ciliary body with a light placed on either the upper or lower lid.
- Fluorescein angiography : A procedure to look at blood vessels and the flow of bloodinside the eye. An orange fluorescent dye (fluorescein) is injected into a blood vessel in the arm and goes into the bloodstream. As the dye travels through blood vessels of the eye, a special camera takes pictures of the retina and choroid to find any areas that are blocked or leaking.
- Indocyanine green angiography: A procedure to look at blood vessels in the choroid layer of the eye. A green dye (indocyanine green) is injected into a blood vessel in the arm and goes into the bloodstream. As the dye travels through blood vessels of the eye, a special camera takes pictures of the retina and choroid to find any areas that are blocked or leaking.
- Ocular coherence tomography : An imaging test that uses light waves to take cross-section pictures of the retina, and sometimes the choroid, to see if there is swelling or fluid beneath the retina.
Biopsy
- A biopsy is the removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. Rarely, a biopsy of the tumor is needed to diagnose intraocular melanoma. Tissue that is removed during a biopsy or surgery to remove the tumor may be tested to get more information about prognosis and which treatment options are best.
- The following tests may be done on the sample of tissue:
- Cytogenetic analysis: A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the chromosomes.
- Gene expression profiling : A laboratory test in which cells in a sample of tissue are checked for certain types of RNA.
A biopsy may result in retinal detachment (the retina separates from other tissues in the eye). This can be repaired by surgery.
When to seek urgent medical care?
Call for an appointment with your health care provider if you have symptoms of melanoma of the eye.
Treatment options
- Five types of standard treatment are used:
Surgery
- Surgery is the most common treatment for intraocular melanoma. The following types of surgery may be used:
- Resection: Surgery to remove the tumor and a small amount of healthy tissue around it.
- Enucleation: Surgery to remove the eye and part of the optic nerve. This is done if vision cannot be saved and the tumor is large, has spread to the optic nerve, or causes high pressure inside the eye. After surgery, the patient is usually fitted for an artificial eye to match the size and color of the other eye.
- Exenteration: Surgery to remove the eye and eyelid, and muscles, nerves, and fat in the eye socket. After surgery, the patient may be fitted for an artificial eye to match the size and color of the other eye or a facial prosthesis.
Watchful Waiting
Watchful waiting is closely monitoring a patient’s condition without giving any treatment until signs or symptoms appear or change. Pictures are taken over time to keep track of changes in the size of the tumor and how fast it is growing.
Watchful waiting is used for patients who do not have signs or symptoms and the tumor is not growing. It is also used when the tumor is in the only eye with useful vision.
Radiation therapy
- Radiation therapy is a cancer treatment that uses high-energy x-rays or other types ofradiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External-beam radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
- Localized plaque radiation therapy is a type of internal radiation therapy that may be used for tumors of the eye. Radioactive seeds are attached to a disk, called a plaque. The plaque is placed directly on the wall of the eye where the tumor is located. The side with the seeds faces the eyeball and delivers radiation to the eye. The plaque, which is often made of gold, helps protect nearby tissues from radiation damage.
- Charged-particle external beam radiation therapy is a type of external-beam radiation therapy. A special radiation therapy machine aims tiny, invisible particles, called protons or helium ions, at the cancer cells to kill them with little damage to nearby normal tissues. Charged-particle radiation therapy uses a different type of radiation than the x-ray type of radiation therapy.
- Gamma Knife therapy is a type of stereotactic radiosurgery used for some melanomas. This treatment can be given in one treatment. It aims tightly focused gamma rays directly at the tumor so there is little damage to healthy tissue. Gamma Knife therapy does not use a knife to remove the tumor and is not an operation.
Photocoagulation
- Photocoagulation is a procedure that uses laser light to destroy blood vessels that bringnutrients to the tumor, causing the tumor cells to die. Photocoagulation may be used to treat small tumors. This is also called light coagulation.
Thermotherapy
- Thermotherapy is the use of heat from a laser to destroy cancer cells and shrink the tumor.
Where to find medical care for Uveal melanoma?
- Check with your doctor if you have any of the following:
- Blurred vision or other change 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.
Prevention of Uveal melanoma
The most important way to prevent eye melanoma is to protect the eyes from sunlight, especially between 10 a.m. and 2 p.m., when the sun's rays are most intense. Wear sunglasses that have ultraviolet protection. A yearly eye exam is recommended.
What to expect (Outlook/Prognosis)?
- The prognosis (chance of recovery) and treatment options depend on the following:
- How the melanoma cells look under a microscope.
- The size and thickness of the tumor.
- The part of the eye the tumor is in (the iris, ciliary body, or choroid).
- Whether the tumor has spread within the eye or to other places in the body.
- Whether there are certain changes in the genes linked to intraocular melanoma.
- The patient's age and general health.
- Whether the tumor has recurred (come back) after treatment.
Possible complications
- Distortion or loss of vision
- Retinal detachment
- Spread of the tumor to other areas of the body