Intraocular Melanoma: Symptoms, Causes, Treatment

What are the symptoms of intraocular melanoma?

Intraocular melanoma, which is a type of eye cancer, may not always cause symptoms in its early stages. However, as the tumor grows, symptoms may include:

1. Blurred vision or changes in vision: This can occur as the tumor affects the retina or optic nerve.
2. Flashes of light: Sometimes described as seeing flashes or flickering lights.
3. Floaters: These are dark spots or shapes that float across your field of vision.
4. Loss of peripheral vision: A gradual loss of side vision can occur as the tumor grows.
5. Distortion of vision: Straight lines may appear bent or wavy.
6. A growing dark spot on the iris or in the eye: This may be noticed as a dark spot on the colored part of the eye (iris) or inside the eye.

If you experience any of these symptoms, especially if they are persistent or worsening, it’s crucial to seek medical evaluation promptly, as early detection and treatment can significantly improve outcomes.

What are the causes of intraocular melanoma?

The exact causes of intraocular melanoma, which is a type of eye cancer involving melanocytes (cells that produce pigment), are not fully understood. However, several factors may contribute to its development:

1. Genetic mutations: Changes in certain genes, such as mutations in the GNAQ, GNA11, or BAP1 genes, have been associated with the development of intraocular melanoma.
2. Exposure to ultraviolet (UV) radiation: Prolonged exposure to UV radiation, such as from sunlight, is a known risk factor for melanoma in general, but its specific role in intraocular melanoma is less clear.
3. Fair skin and light eye color: People with fair skin and light-colored eyes (blue or green) may have a higher risk of developing intraocular melanoma.
4. Ocular melanocytosis: This is a benign condition where there is an increased number of melanocytes in the eye, which may increase the risk of developing melanoma.
5. Age and gender: Intraocular melanoma tends to occur more frequently in older adults, typically over the age of 50. There may also be a slight male predominance.
6. Other factors: Some studies suggest a possible association between intraocular melanoma and certain occupations or environmental exposures, but more research is needed to establish clear causative links.

It’s important to note that while these factors may increase the risk of developing intraocular melanoma, not everyone with these risk factors will develop the condition, and some individuals without these factors may still develop it. Regular eye exams and early detection are crucial for managing and treating intraocular melanoma effectively.

How is the diagnosis of intraocular melanoma made?

Diagnosis of intraocular melanoma involves several steps and examinations by an eye care specialist (ophthalmologist or optometrist). Here’s how the diagnosis is typically made:

1. Symptoms and Medical History: The process often begins with discussing any symptoms you may be experiencing and your medical history, including any family history of eye diseases or cancer.
2. Visual Acuity Test: This standard eye test checks how well you can see at various distances.
3. Slit-Lamp Examination: This is a microscope with a bright light that allows the doctor to examine the structures of your eye, including the retina, iris, and lens.
4. Dilated Eye Exam: Your pupils are dilated using eye drops to allow the doctor to see the back of your eye more clearly.
5. Ophthalmoscopy: The doctor uses a special instrument called an ophthalmoscope to examine the inside of your eye, including the retina and optic nerve.
6. Ultrasound Imaging: This imaging technique uses high-frequency sound waves to create detailed images of the inside of the eye. It can help detect the presence, size, and location of tumors.
7. Fluorescein Angiography: A dye is injected into a vein in your arm, and as it travels through the blood vessels in your eye, photographs are taken to evaluate blood flow and detect abnormalities.
8. Optical Coherence Tomography (OCT): This non-invasive imaging test uses light waves to take cross-sectional images of the retina and other structures within the eye, helping to detect and monitor changes in the tumor.
9. Biopsy (if necessary): In some cases, a small sample of tissue from the tumor may be collected for examination under a microscope to confirm the diagnosis.

Once intraocular melanoma is diagnosed, further tests may be done to determine the extent (stage) of the cancer and to plan appropriate treatment. Prompt diagnosis and evaluation by an eye specialist are crucial for managing intraocular melanoma effectively.

What is the treatment for intraocular melanoma?

The treatment for intraocular melanoma, also known as uveal melanoma, depends on several factors, including the size and location of the tumor, its growth pattern, and the patient’s overall health. The main goal of treatment is to remove the tumor and prevent it from spreading to other parts of the eye or to other parts of the body. Here are some common treatments for intraocular melanoma:

1. Enucleation: Surgical removal of the entire eye (enucleation) is often the primary treatment for uveal melanoma. This surgery can be done under local anesthesia or general anesthesia.
2. Exenteration: In some cases, the tumor may be too large or invasive to be removed with enucleation alone. Exenteration involves removing the entire orbit (eye socket) along with the tumor.
3. Radiotherapy: Radiation therapy can be used to treat small tumors or as an adjuvant therapy after surgical removal of a larger tumor. There are two types:
   • External beam radiation therapy (EBRT): High-energy radiation beams are directed at the tumor from outside the body.
   • Plaque radiotherapy: A small radiation source is placed directly on the surface of the eye during surgery.
4. Transpupillary thermotherapy (TTT): This is a non-invasive treatment that uses a laser to heat up and destroy the tumor cells.
5. Choroidal melanoma brachytherapy: This is a minimally invasive procedure that uses a small radiation source implanted in the eye to destroy the tumor.
6. Systemic chemotherapy: In rare cases, systemic chemotherapy may be used if the tumor has spread to other parts of the body.

In addition to these treatments, patients with intraocular melanoma may also receive:

• Laser therapy to reduce blood vessel growth and prevent bleeding
• Intravitreal injections to reduce inflammation and prevent complications
• Glaucoma surgery to manage increased eye pressure

It’s essential to note that treatment for intraocular melanoma is usually tailored to each individual patient, and a comprehensive evaluation by an ophthalmologist and other specialists is necessary to determine the best course of treatment.

Would you like me to provide more information on any specific aspect of treatment or patient outcomes?