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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

A form of localized radiation therapy where a small gold-backed disc, or “plaque,” containing radioactive seeds is sewn onto the outside of the eye, directly over the tumor. It stays in place for several days to deliver targeted radiation before being removed. This is the most common treatment for ocular melanoma in the U.S., with outpatient procedures typically used for placement and removal. Special slotted plaques may be used for tumors near the optic nerve.

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Proton Beam Radiation

A highly targeted external radiation treatment that uses charged proton particles to destroy the tumor while minimizing damage to nearby healthy eye tissues. Each proton beam plan is tailored to the tumor’s size, shape, and depth. Treatment is typically delivered once a day over five consecutive days and requires coordination with specialized treatment centers.

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Laser Therapy

Primarily used for small melanomas or to follow up after radiation treatment. Laser therapy applies concentrated heat or light energy to the tumor to destroy cancerous cells. While not suitable for all cases, it can be an effective non-invasive option for specific tumor types.

Enucleation

Surgical removal of the eye, most often reserved for large tumors or when vision cannot be preserved. A conformer is placed at the time of surgery to maintain the shape of the socket, and a prosthetic eye is usually fitted later. In some cases, especially when the tumor has spread beyond the eye, the entire socket and surrounding tissues may also need to be removed.

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Conjunctival Melanoma Treatment

These tumors arise on the surface of the eye and are often treated with surgical excision. Depending on the tumor’s behavior and center protocols, adjuvant radiotherapy or chemotherapy eye drops may be used to reduce the risk of recurrence. Advanced cases may require more extensive surgery, including exenteration. Outcomes depend heavily on the tumor’s size, location, and progression.

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Post-Treatment Considerations

Radiation and surgical treatments can lead to long-term side effects, including fluid buildup, increased eye pressure, retinal detachment, or vision changes. Ongoing monitoring through regular eye exams is essential for managing late-onset complications and detecting any recurrence as early as possible.

Orbital Exenteration

Orbital exenteration is a radical surgical procedure used to treat advanced conjunctival melanoma when the cancer has spread beyond the conjunctiva into deeper orbital tissues. While it is a life-saving measure, it is also physically and emotionally impactful.

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