Eye Melanoma

1 What is Eye Melanoma?

Ocular (eye) melanoma, often termed as eye cancer develops in the Ocular cells which produces melanin.

Melanin are the pigments found in skin throughout the skin and it gives color to the skin. Similarly, eyes also have melanin producing cells. Thus, eyes can develop melanoma too.

Most eye melanomas can only be diagnosed using sophisticated optical instruments. It is difficult to locate melanomas just by looking at a mirror.

Typical sign and symptoms are absent in early stages making diagnostic procedure tough. However, treatment is available.

Vision impairment may not be a problem while treating some small eye melanomas but may induce some loss of vision while treating larger ones.

2 Symptoms

Early sign and symptoms of eye melanoma may not be depicted but seek immediate visit to a doctor if there are sudden changes in your vision.

Some symptoms that appears in later stages of eye melanoma are as follows:

  • A growing dark spot on the iris
  • A sensation of flashing lights
  • A change in the shape of the dark circle (pupil) at the center of your eye
  • Blurred vision
  • Loss of peripheral vision
  • Sensation of flashes and specks of dust in your vision
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3 Causes

No facts and clear reasons are available for the cause of eye melanoma.

However, theory suggests that there should be some errors developed in the DNA of healthy eye cells. The DNA errors guides the cells to grow and multiply in an uncontrolled fashion and the mutated cells do not die as they were expected.

Such mutated cells accumulate in the eye and form an eye melanoma most commonly in the cells of the uvea, the vascular layer of your eye sandwiched between the retina, the thin layer of tissue that lines the back inner wall of your eyeball, the white of your eye (sclera), iris and ciliary body, choroid layer and conjunctiva).

IT may occur in the socket that surrounds the eyeball and on the eyelid but these types of eye melanoma are rare.

4 Making a Diagnosis

Making a diagnosis of eye melanoma is done by performing several tests.

Start by seeing your family doctor or a general practitioner if you have any signs or symptoms that worry you. If your doctor suspects you have an eye problem, you may be referred to an eye specialist (ophthalmologist) or an eye surgeon.

Be prepared before visiting a doctor.

Follow these tips to make the conversation clear, precise and fruitful:

  • Write down any symptoms you're experiencing.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements that you're taking.
  • Consider taking a family member or friend along with you for your comfort as well as not to miss your doctor’s recommendations.

What to expect from your doctor

Make a list of questions you wish to ask your doctor.

Few important questions might be as follows:

  • Do I have eye melanoma?
  • Where is my eye melanoma located?
  • What is the size of my eye melanoma?
  • Has my eye melanoma spread beyond my eye?
  • Will I need additional tests?
  • What are my treatment options?
  • Is there a cure for my condition? If yes, what are the potential side effects of the treatment?
  • How long can I take to decide on a treatment?
  • Is there one treatment you feel is best for me?
  • How will treatment affect my daily life?
  • Can I continue working?
  • How will treatment affect my vision?
  • I have these other health conditions. How can I best manage them during treatment?
  • Should I be referred to additional specialists? What will that cost, and will my insurance cover it?
  • Are there brochures or other printed material that I can take with me?
  • What websites do you recommend?
  • What will determine whether I should plan for a follow-up visit?

Apart from these, feel free to ask any question to your doctor.

What your doctor may ask

  • When did you first begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?

To diagnose eye melanoma, your doctor may recommend few tests which are as follows:

  • Eye exam: Doctor will examine your eye, looking for enlarged blood vessels that can indicate a tumor inside the eye. Ophthalmoscopy is one of the methods that uses lens and a bright light mounted on doctor's forehead. Another method, called slit-lamp bio microscopy uses a microscope that produces an intense beam of light to illuminate the interior of the eye.
  • Eye ultrasound: An eye ultrasound uses high-frequency sound waves from a hand-held, wand-like apparatus called a transducer to produce images of eye. The transducer is placed on your closed eyelid or on the front surface of your eye.
  • Angiogram: During this process a colored dye is injected into a vein of your arm. The dye travels to the blood vessels in your eyes. A camera with special filters to detect the dye takes flash pictures every few seconds for several minutes.
  • Biopsy: Sometimes removing a sample of suspicious tissue for testing may be recommended. To remove the sample, a thin needle is inserted into the eye and suspicious tissue is extracted. The tissue is tested in a laboratory to determine whether it contains eye melanoma cells.
  • Determining whether cancer has spread

Your doctor may also recommend additional tests and procedures to determine whether the melanoma has spread (metastasized) to other distant parts of your body.

Tests may include:

  • Blood tests to measure liver function
  • Chest X-ray
  • Computerized tomography (CT) scan
  • Magnetic resonance imaging (MRI)
  • Abdominal ultrasound, etc.

5 Treatment

Treatment plan for eye melanoma depends on size and location of melanoma. Three primary treatment options are: surgery, chemotherapy and radiation.

A small eye melanoma when suspected may not require immediate treatment but enough attention should be made to observe the signs of growth.

If the melanoma grows or causes complications, immediate treatment is necessary.

  • Surgery: Surgical process may require the removal of certain part of the eye or the entire eye. Surgery to remove the melanoma and a band of healthy tissue that surrounds it may be an option for treating small melanomas. Respective name for surgical processes have been assigned depending upon the location where the surgery is carried out. Iridectomy (Iris) and choroidectomy (choroid) are some examples. Surgery to remove the entire eye is called enucleation. It is often used for large eye tumors associated with intense pain. Enucleation requires a prosthetic (artificial) eye to be replaced which will be custom painted to match the existing eye.
  • Radiation therapy: High energy beams such as protons or gamma rays are used to kill cancer cells. Radiation therapy is suitable for small to medium-sized eye melanomas. Brachytherapy is a technique that involves placing a radioactive plaque on eye directly over the tumor and applying radiation to it. Such plaques are removed only after four to five days. Alternatively, sources of radiation may be a machine that directs radiation to your eye (external beam radiation or teletherapy) requiring several days for treatment.
  • Laser treatment: Laser treatments like thermotherapy uses an infrared laser and is often used in combination with radiation therapy.
  • Cryotherapy: Freezing melanoma cells to death may be used in some small eye melanomas, but this treatment is rare.

6 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with eye melanoma.

A complete loss of one eye may make your life difficult.

Sometimes coping with such delicacies may require expert advices.

It is better to stay positive. It is still possible to do most things you were able to do with two working eyes.

Regarding your altered vision, take some time to build up some confidence to judge the things around you.

7 Risks and Complications

There are several risks and complications associated with eye melanoma.

Risk factors for eye melanoma are as follows:

  • Age: The risk of eye melanoma increases with age.
  • Light eye color: People with blue eyes or green eyes have a greater risk of melanoma of the eye. Similarly, white people are at greater risk than other races.
  • Certain inherited skin disorders. A condition called dysplastic nevus syndrome, which causes abnormal moles may increase your risk of developing melanoma on your skin and eye. In addition, people with abnormal skin pigmentation involving the eyelids and adjacent tissues and increased pigmentation on their uvea known as ocular melanocytosis also have an increased risk of developing eye melanoma.
  • Exposure to ultraviolet (UV) light: There's some evidence that exposure to UV light, such as light from the sun or from tanning beds may increase the risk of eye melanoma.

Complications of eye melanoma are as follows:

  • Glaucoma: A growing eye melanoma may cause glaucoma. Signs and symptoms of glaucoma are eye pain, redness and blurred vision.
  • Vision loss: Large eye melanomas may induce complications such as retinal detachment which often leads to impaired vision. Small eye melanomas can cause some vision loss if they occur in critical parts of the eye. You may have difficulty seeing in the center of your vision or on the side. Highly advanced melanomas can cause complete blindness.
  • Eye melanoma can spread to distant body parts including the liver, lungs and bones.
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