Melanoma of the Eye

The Causes, Symptoms, Treatment and Prevention of Melanoma of the Eye

What is eye melanoma (ocular melanoma), what are the symptoms, and how is this type of cancer treated?. Credit: Photo©wildpixel

Ocular melanoma, or melanoma of the eye, is a rare type of cancer that affects various parts of the eye, specifically the choroid, ciliary body, and the iris. Choroidal melanoma is the most common type of eye malignancy.

Eye Melanoma (Ocular Melanoma) - Origin

Many people are confused by the melanoma aspect of this type of eye cancer, as melanoma is most commonly associated with the skin. Melanomas develop from melanocytes, cells that contain the dark pigment (melanin) that defines our skin coloring.

Melanocytes aren't exclusive to the skin -- they can be found in the hair, the eyes, and the lining of some organs.

Eye melanoma usually begins in the middle layer of the eye known as the uvea.  This is the layer in which the blood vessels travel through the eye.  The outer layer is the sclera (the thick white part) and the inner layer is the retina (where the rods and cones that are the sensory part of the eye pick up signals to send to the brain.)  Sometimes melanoma also occurs on the conjuctiva or eyelid.

This cancer is most common in older people and peaks at around age 70.  It is found more often in men than in women.  Ocular melanomas account for around 5% of melanomas.

What Causes Ocular Melanoma?

Like many other types of cancer we aren't quite sure what causes ocular melanoma, but there is suspicion that it is related to exposure to the UV rays of the sun. This theory has yet to be proven, however.

Even though the cause of ocular melanoma has yet to be pinpointed, researchers have identified risk factors for the disease. Risk factors for ocular melanoma are similar to risk factors for melanoma of the skin and include:

  • Being fair skinned or having a light hair color and eye color (blue or green eyes)
  • Prolonged exposure to sunlight or tanning beds
  • The ability to tan
  • Caucasian race
  • Having dysplastic nevus syndrome, a condition that causes abnormal moles
  • Having abnormal pigmentation of the eyelid or uvea
  • Having oculodermal melanocytosis, a rare condition that causes increased and abnormal pigmentation of the eye and skin around the eye

Researchers are learning much more about cancer genetics and melanoma and it's thought that 55% of one's risk for melanoma is due to genetic factors.

Symptoms of Ocular Melanoma

There are sometimes no noticeable symptoms of ocular melanoma, especially in the early stages. In these instances, melanoma of the eye is usually diagnosed through a routine eye screening by an optician or opthalmologist. Ocular melanoma symptoms include:

  • Blurred vision in one eye
  • Floaters (small "floating" spots in your vision field)
  • Change in iris color or dark spot on the iris
  • Change in the shape of the pupil
  • Seeing flashing lights
  • Red and/or painful eye
  • Bulging eye
  • Loss of peripheral vision or loss of all vision

    Due to most common locations of these tumors, people are usually unable to spot the cancer themselves - in other words, they are not usually visible in the mirror.

    Diagnosing Ocular Melanoma

    Unlike other types of cancer, a biopsy is not usually needed for most cases of ocular melanoma. One of the first tests most people have is called an ophthalmoscopy, which uses a special scope to get an in-depth view of the eye. It is much like the tool your optician or physician uses to look at your eye. It is noninvasive and is painless and done after your eye doctor first dilates your eyes.

    An ultrasound may also be done to view the eye and surrounding structures. Numbing drops are given before the scan to prevent any discomfort. You may be asked to look in different directions to allow for different angles of viewing. Eye ultrasounds generally take about 15 minutes or less.

    Other tests, like an MRI or CT scan, may be done if it is suspected that the cancer has spread beyond the eye. The liver is one common site of metastasis for ocular cancer.  This list shows where melanoma commonly spreads.

    Treatment of Ocular Melanoma

    Treatment of ocular melanoma is based on what part of the eye is affected and whether it has metastasized to other parts of the body.

    Surgery is one method for treating melanoma of the eye. Removal of the eye (enucleation) may be necessary in some cases of large tumors when other treatment methods are not suitable. An artificial eye can be created in most cases. Prosthetic eyes today are much more realistic than in the past. They are created by talented, trained individuals called ocularists. It generally takes anywhere from 4 to 6 appointments to be fitted for a prosthetic eye and for it to be placed. Quality and artistic talent are two important characteristics to consider when choosing an ocularist.

    Radiation therapy is also a common treatment for ocular melanoma. It may be the sole treatment or done after surgery. There are two types of radiation therapy: external and internal. Both use specific types of energy to disrupt the activity of cancer cells to eliminate them and prevent them from undergoing cell division.

    • External radiation delivers radiation from a specialized machine that targets the tumor site externally. This method of radiation is specific and limits the damage to surrounding tissue.
    • Internal radiation (brachytherapy), often called plaque therapy when referencing the treatment of ocular melanoma, uses a radioactive "seed" or "plaque" that is implanted near the tumor site to deliver therapy. Normally, it remains implanted for about 7 days and is then removed.  This is the most common type of radiation therapy used for eye melanoma.

    Radiation therapy is effective against ocular melanoma, but does not come without side effects. Red, dry eyes are a common side effect. Cataracts sometimes result from therapy, but surgery may be an option to remove them. Eyelash loss and shortening may also occur. Less commonly, radiation therapy can cause optic nerve damage, glaucoma, and abnormal blood vessels in the retina.

    Treatment of metastatic melanoma is usually similar to that for other types of metastatic melanoma.  Though good treatments are mostly lacking for metastatic disease, several options for melanoma chemotherapy exist. 

    In addition, clinical trials looking at targeted therapies as well as immunotherapy are in progress and show promise that this will change in the future.


    American Academy of Opthalmology. What is Ocular Melanoma. Updated 08/02/12.

    Blum, E., Yang, J., Komatasubara, K., and R. Carvajal. Clinical Management of Uveal and Conjunctival Melanoma. Oncology (Williston Park). 2016. 30(1):29-32,34-43,48.

    Chattopadhay, C., Kim, D., Gombos, D. et al. Uveal melanoma: From diagnosis to treatment and the science inbetween. Cancer. 2016 Mar 15. (Epub ahead of print).

    National Cancer Institute. Intraocular (Uveal) Melanoma Treatment - for Health Professionals (PDQ). Updated 07/09/15.

    Continue Reading