Eye melanoma (ocular, uveal melanoma, melanoma of conjunctiva, eyelid melanoma) is a cancer that develops from melanocytes, cells that produce melanin pigment which is responsible for the color of the skin and eyes.
New approach of immunotherapy medicines allows our oncologists to increase significantly treatment results and improve quality of life of our patients.
Melanoma of the eye membranes – intraocular tumor, which is most common in adults. Ocular shell is a layer of the eye that includes an iris regulating the amount of light entering the eye and the ciliary body which is in the area of the lens. It helps to modify the convexity of the target image (the choroid, which is located beneath the retina and feeding it). All these structures are a rich source of melanocytes.
These tumors rarely occur before the age of 20 years. Melanoma is more common in people with fair skin, light hair and light eyes, and it is most common in the Nordic countries. In addition, there are other factors such as ocular melanosis, oculodermal melanocytosis, dysplastic nevi and smoking.
Prof. Jacob Schachter – Head of the Ella Lamelbaum Institute for Melanoma and Immunooncology at Sheba Academic Medical Center, Chaim Sheba Hospital, Israel. Deputy Director of Oncology Department of Chaim Sheba Hospital.
Advanced melanoma treatment:
Uveal melanoma symptoms
Symptoms of uveal melanoma include blurred vision, loss of sight, objects or points of view, the flash of light. Often the disease is detected before the appearance of symptoms during a routine eye examination. For the early diagnosis of melanoma risk people must pass eye examination once a year.
Symptoms caused uveal melanoma are not unique to this disease and may also occur in other diseases. Ophthalmologist can diagnose diseases by means available in the eye clinics.
Diagnosis of uveal melanoma
Diagnosis can be started with a tour of the lamp as the iris is the visible part of the eye. Ultrasound examination of the eye helps in the diagnosis of melanoma of the iris and the assessment of its scope.
Ciliary body melanoma develops on the back of the eye, so its diagnosis requires deeper imaging. Unlike other cancers, there is usually no need for biopsy. Diagnosis can be made with high-precision non-invasive methods.
The most important tool for the diagnosis of melanoma are ophthalmoscope (an instrument for clinical examination of the eye (fundus) and the study of the retina) and ultrasound of the back of the eye. Ultrasound is the most important tool for the diagnosis of intraocular tumors.
In some cases also angiography with contrast may be used.
CT (computed tomography) and MRI (magnetic resonance imaging) are used only in complex cases, for example when the tumor comes out the eye.
Treatment of uveal melanoma
Since melanoma is a cancer it can harm the eye and endanger human life. The main priority of our doctors in the treatment of melanoma – the life, the eye and vision. Our experts will do everything possible to save the eye, but sometimes in order to save the patient’s life they recommend the removal of pathological source.
There are various methods of uveal melanoma treatment which are dependent on tumor size and location, general condition and others. The goal of treatment is to destroy the tumor cells and prevent relapse to store the eye.
Brachytherapy (local irradiation). This method is the most common. In the damaged layer of the eye plate with radioactive material is placed and it remains there for a few days (in accordance with the calculation determined individually for each patient). Plate itself is a source of radiation, and radiation is only increased following ocular tissues. Removing the plate and results evaluation is performed under local anesthesia.
Enucleation (eye removal). In cases where treatment of melanoma not amenable to radiotherapy (usually at large tumors), physicians may recommend a total eye removal. Previously, this method has been most widely used, but in recent years in Israel only in a minority of cases the tumor removed by this method. After removal of the necessary reconstruction of the eye (ocular prosthesis implantation).
External exposure. Unlike local emission radiation from an external source may be projected on the distant tissue. Standard external radiation therapy used to treat other types of cancer, and it is not an effective method for the treatment of uveal melanoma.
Stereotactic radiosurgery. This technique began to be used in some cases for the treatment of uveal melanoma is only in recent years. This radiation using special equipment extends from several directions.
Surgical resection of the tumor. In those cases where melanoma has a limited size, particularly when it is in front of the eye can be resection by establishing “window” in the eye. This operation is performed only for the removal of tumors of small diameter.
Heat treatment (transpupillary thermotherapy). During this procedure the tumor is heated by a special laser beam which destroys the portion of cancer cells. In recent years this method of treatment is used as an adjunct to radiation therapy.
Because uveal melanoma can spread to other parts of the body, patients treated must undergo periodic liver function tests – imaging scan (ultrasound and/or CT) of the liver and liver function tests (blood tests). These tests are usually necessary to carry out once every six months. Other possible spread of melanoma is to lungs and bones, but the spread of tumors in these organs are usually occurs only after finding a cancerous tumor in the liver. The most of cases of uveal melanoma are one-sided.
Advanced treatment of metastatic eye melanoma is immunotherapy, biological treatment and TIL therapy. The treatment method is defined by our oncologist according to the test results.
Melanoma of the conjunctiva
Conjunctiva is a transparent mucous membrane that covers the sclera and lines the inside of the eyelid. Conjunctiva produces mucus and tears.
Melanoma of the conjunctiva is a much rarer disease than uveal melanoma. Melanoma usually occurs because of defeats pigments called conjunctival primary acquired melanosis of the conjunctiva. These flat spots usually appear in adults.
Sometimes, melanoma can develop from nevus of the conjunctiva, and sometimes without any pigment. Because of the risk of developing melanoma of the conjunctiva, any new pigment spots conjunctiva in adults should undergo biopsy, or be completely removed.
If the diagnosis of melanoma is confirmed by histological examination melanoma should be removed, and cryotherapy (freezing) on this area should be performed.
In the case of a patient acquired melanosis (PAM) of the conjunctiva, there is a risk of developing melanoma. In this case, the patient can be offered a local chemotherapy using drops which gives very good results and prevents the development of melanoma.
Melanoma of conjunctiva can spread to other parts of the body but as a rule, first it is distributed to nearby lymph nodes – behind the ears and around the lower jaw. Monitoring of patients with melanoma conjunctiva ability to monitor the growth potential of these glands and if they grow a biopsy of node should be performed.
Melanoma of the eyelid skin is extremely rare. This growth usually occurs because of increased pigment of eyelid or distribution of the pigment of the conjunctiva.
Malignant eyelid melanoma differs from uveal melanoma that growth can be volatile pigmentation and/or accompanied by bleeding. All pigmented eyelid tumors should be investigated by experienced ophthalmologist.
Diagnosis of melanoma of the eyelid skin
All tumors of this type to be monitored. If pigmentation changes you must perform a biopsy of the eyelid to get pathological assessment (laboratory abnormalities eyes).
Treatment of eyelid melanoma
If a diagnosis of eyelid melanoma physician must make additional diagnostics to prevent metastatic spread to other parts of the body. If metastases are found, they may be surgically removed. During the operation it may sometimes be resection of regional lymph nodes.
After surgical approach the reconstruction of the eyelid should be done by experienced oculoplastic surgeon.