A Diagnosis of ocular melanoma can be a very confusing and anxious time. ACIS strives to provide information to make education of treatments and follow up easier to understand. While ACIS provides information, it should not be taken as medical advice and you should always speak to your doctor about your treatment plan. Being an informed patient will allow you to have the best possible experience and outcome. Second opinions for self-advocacy is always a good idea.
Ocular Melanoma Treatments
Most uveal melanomas are treated with some form of radiotherapy. A few tumors can be surgically removed, either whole or in fragments. Some very small melanomas are treated with laser. Removal of the eye (enucleation) is performed only when such treatments are unlikely to conserve a comfortable and seeing eye.
Plaque – Brachytherapy or radiation treatment is used to treat most ocular melanomas. Plaques are made of gold shells that house special radiation seeds. The plaque is placed in the eye and left for several days then removed. The insert and removal is usually done outpatient but you may be required to stay in the hospital during treatment. Some tumors close to the optic nerve will require a special slotted plaque. Plaque is the most widely used in the United States.
Proton Beam – A radiation beam is a finely target beam with adjustable penetration that is customized for each patient and their specific tumor type. Proton beam generally has less damage to the surrounding tissue of the eye while treating the tumor. Proton beam treatment generally spans one week with once a day treatments.
Laser – Small tumors can sometimes be treated by laser alone. Laser is also used to assist after plaque therapy.
Enucleation – Removal of the eye and sometimes the socket depending on the tumor. The eye is usually fitted with a conformer in anticipation of a prosthetic eye. Sometimes a prosthetic is not an option and the eye is sutured shut.
Conjunctival melanomas are usually treated by surgical removal of the lesion, which in some centers is followed by radiotherapy to prevent the tumor from returning. Flat melanomas confined to the conjunctival surface are often treated with chemotherapy drops. Very rarely, advanced conjunctival melanomas require removal of the eye and surrounding tissues (exenteration). The chances of saving the eye and vision vary greatly depending on the size, location, and extent of the tumor. Latent side effects due to radiation treatment, such as fluid leakage from an irradiated tumor, detached retina, raised eye pressure, and other inner eye problems, can require extended treatments over years post-treatment. Regular examinations are necessary to detect and treat any recurrent tumor without delay.