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Treatments and drugs
By Mayo Clinic staffAfter eye melanoma is diagnosed, you and your doctor will review your treatment options. Factors to be considered are the location and size of the melanoma, as well as your overall physical health. Some doctors may also consider the genetics of the tumor (cytogenetics) when deciding on the best treatment course. However, this is a topic currently being debated in the medical community and some experts feel that more studies are needed to determine the best type of profiling for predicting tumor behavior and outcomes.
Melanomas of the eye are rare, so it's a good idea to find a doctor with experience in treating these cancers. In addition, a second opinion can provide more information and help you feel more confident about your treatment plan.
Sometimes, doctors suggest observing a small lesion rather than treating it right away. But your doctor will generally recommend treatment for a medium-sized or large-sized melanoma.
Treatment designed to destroy a melanoma often will cause some loss of vision, even though every effort is made to preserve vision. But because cancers of the eye can be fatal, in some cases you'll need treatment even if it means loss of vision or loss of your eye.
Surgery is the foundation for most eye cancer treatments. If an eye melanoma is of a certain size and in a favorable location, treatment can sometimes be accomplished with surgery alone. Treatment for other eye melanomas may be done with radiation alone, or radiation combined with a therapy such as infrared laser.
Surgery
Depending on the characteristics of the tumor, your doctor may choose from a variety of surgical procedures to remove the melanoma:
- Iridectomy. This procedure removes only a part of the iris. It's used for small iris melanomas that have not invaded other structures of your eye.
- Iridotrabeculectomy. This procedure removes parts of the iris and the supporting tissues around the cornea at the base of the iris for small iris melanomas that have invaded those tissues.
- Iridocyclectomy. This is another treatment for small melanomas of the iris and ciliary body. It involves removing part of the iris and the ciliary body.
- Choroidectomy. Part of the choroid is removed during this surgery, with or without removing part of the wall of the eye (sclerouvectomy). This complicated procedure may be followed by supplementary radiation.
- Enucleation. This surgery removes the entire eye. This procedure is used for large eye tumors when alternative treatments would destroy most of the eye anyway. It may also be used if the tumor is causing eye pain. An implant is inserted into the position where the eye was previously located, and the muscles controlling movement of the eye are attached to it, which will allow the implant to move. After your eye has had some time to heal, an artificial eye (prosthesis) is made. The front surface of your new eye will be custom painted to match your existing eye, and the back surface will be custom molded so it fits comfortably. Motion from the implant is transferred through the healed tissue to the prosthetic eye, which in most cases provides a satisfactory cosmetic appearance. You can wear the prosthetic eye all the time and even sleep with it in place, but you'll have to remove it once or twice a year for polishing.
Radiation therapy
Carefully targeted and regulated doses of high-energy radiation — radiation therapy — can destroy ocular melanoma and be lifesaving.
Radiation therapy damages cells by destroying the genetic material that controls how cells grow and divide. And although both healthy and cancerous cells are damaged by radiation, the goal of treatment is to hurt as few normal, healthy cells as possible.
Doctors generally reserve radiation treatment for eye melanomas to medium-sized and large-sized melanomas, although selected small-sized melanomas may sometimes be treated with radiation. The radiation dose can be delivered with charged particles such as proton beams, which are generated from outside of your body and directed into your eye (teletherapy). Or, the radiation can come from small radioactive seeds that are temporarily anchored to your eye (brachytherapy).
In brachytherapy, a small implant (plaque) similar to a bottle cap and containing several radioactive seeds (usually iodine 125 seeds) is sutured to the wall of your eye at a site overlying the tumor. The plaque remains in place for four to five days until it has delivered an optimal amount of radiation for the characteristics of your tumor. The device is then removed, and your doctor will monitor the tumor at regular intervals to watch for tumor shrinkage.
Small eye melanomas
There has been a recent trend toward treating small eye melanomas with either radiation therapy or transpupillary thermotherapy (TTT) — a type of infrared laser therapy — or both. Destroying the cancerous tissue by freezing it (cryotherapy) also has been used for some small eye melanomas.
