Eye melanoma is a kind of eye cancer that starts in cells within the eye that make melanin. Melanin is most often known as the pigment that gives skin its color. But the eyes have cells that make melanin too. Eye melanoma also is called ocular melanoma, intraocular melanoma and uveal melanoma.

Most eye melanomas form in parts of the eye you can't see when looking in a mirror. That makes eye melanoma hard to notice. And eye melanoma typically doesn't cause symptoms at first.

Eye melanoma can be treated. Treatment for small eye melanomas may not cause vision problems. But treatment for large eye melanomas typically leads to some vision loss.

Symptoms

Eye melanoma may not cause any symptoms. When they do happen, signs and symptoms of eye melanoma can include:

• Flashes of light or what look like specks of dust in a person's vision. These are sometimes called floaters.
• A growing dark spot in the colored part of the eye, called the iris.
• A change in the shape of the pupil. The pupil is the dark circle at the center of the eye.
• Poor vision or blurry vision in one eye.
• Not being able to see when looking to the side. This is called loss of peripheral vision.

When to see a doctor

Make an appointment with a healthcare professional if you have any symptoms of eye melanoma. If you notice sudden changes in your vision, seek emergency medical care right away.

Causes

It's not clear what causes eye melanoma.

Eye melanoma happens when cells in the eye develop changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA tells the cells to grow and multiply at a set rate. The DNA also tells the cells to die at a set time.

In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to grow and multiply quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.

The cancer cells might form a mass called a tumor. The tumor can grow to invade and destroy healthy tissue. In time, cancer cells can break away and spread to other parts of the body. When cancer spreads, it's called metastatic cancer.

Where eye melanoma develops

Eye melanoma most often happens in the cells of the middle layer of the eye, called the uvea. The uvea has three parts. Each part can be affected by eye melanoma:

• The iris. The iris is the colored part at the front of the eye.
• The choroid layer. The choroid layer is a layer of blood vessels and connective tissue. It's located at the back of the uvea.
• The ciliary body. The ciliary body is located behind the iris. It helps the eye focus. It also makes a transparent liquid, called aqueous humor, that fills the front part of the eye.

Eye melanoma can happen in other parts of the eye. But this is very rare. Other parts of the eye that can develop melanoma include:

• The layer on the front of the eye, called the conjunctiva.
• The socket that surrounds the eyeball, called the orbit.
• The eyelid.

Risk factors

Risk factors for eye melanoma include:

• Light eye color. People with blue eyes or green eyes have a higher risk of melanoma of the eye.
• Being white. White people have a greater risk of eye melanoma than do people of other races.
• Age. The risk of eye melanoma goes up with age.

• Certain inherited skin conditions. A condition called dysplastic nevus syndrome, which causes unusual moles, can raise the risk of eye melanoma.

  People who have a condition called ocular melanocytosis also are at higher risk of eye melanoma. This condition involves unusual skin pigmentation on the eyelids and in the tissue around the eyelids. It also leads to more pigmentation on the eye's uvea.

• Certain genetic changes. Some DNA changes that are passed from parents to children may raise the risk of eye melanoma.
• Exposure to ultraviolet light. Some research suggests that exposure to ultraviolet light could raise the risk of eye melanoma. Sources of ultraviolet light include the sun, as well as tanning beds.

Healthcare professionals haven't found anything that can prevent eye melanoma.

Complications

Some people develop other health concerns linked to eye melanoma. These are called complications. They can include the following:

Vision loss

Eye melanoma can cause vision loss. Sometimes the vision loss is a symptom of an eye melanoma. Sometimes vision loss is caused by eye melanoma treatment.

Eye melanoma that spreads beyond the eye

Eye melanoma can spread outside of the eye to other areas of the body, including the liver, lungs and bones.

Diagnosis

Eye melanoma diagnosis often starts with an eye exam. Imaging tests can help show the size of the cancer.

Eye exam

During an eye exam for eye melanoma, a healthcare professional may first examine the outside of the eye. The health professional may look for blood vessels that are larger than usual. Large blood vessels might mean there's something concerning happening inside the eye.

An eye exam also involves looking inside the eye with the help of special equipment. One way to do that uses lenses and a bright light mounted on a healthcare professional's forehead. This is called binocular indirect ophthalmoscopy. Another method uses lenses and a microscope that has an intense beam of light that lights up the inside of the eye. This is called slit-lamp biomicroscopy.

Fundus photography

Fundus photography is a test that takes color pictures of the inside surface of the eye. This part of the eye is called the fundus. Fundus photography can show an eye melanoma. The test might be repeated to watch a melanoma over time. Different kinds of tests can take pictures of the fundus to show an eye melanoma. One example is fundus autofluorescence.

Eye ultrasound

An eye ultrasound uses high-frequency sound waves to make images of the eye. The sound waves come from a device that looks like a wand, called a transducer. A healthcare professional places the transducer on the closed eyelid or on the front surface of the eye to get the pictures.

Eye angiography

Angiography is a test that makes pictures of the blood vessels. To get pictures of the blood vessels in the eye, a colored dye is injected into a vein in an arm. The dye travels to the blood vessels in the eye. A camera with special filters to detect the dye takes pictures of the eye every few seconds for several minutes. Tests that can make pictures of the blood vessels in the eye include fluorescein angiography and indocyanine green angiography.

Optical coherence tomography

Optical coherence tomography is an imaging test that uses light waves to make pictures of the eye. It can make pictures of the uvea and the retina that might show an eye melanoma.

Eye melanoma biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. A biopsy typically isn't necessary to diagnose eye melanoma. But it may be used in some situations. Sometimes a biopsy may be done at the time of treatment to get more information about the cancer cells.

Testing for cancer spread

Other tests may be needed to see if melanoma has spread to other parts of the body. The tests may include:

• Blood tests.
• Tests to check how well the liver works.
• Chest X-ray.
• Ultrasound.
• Computerized tomography scan, also called CT scan.
• Magnetic resonance imaging, also called MRI.
• Positron emission tomography scan, also called PET scan.

Treatment

Not all eye melanomas need treatment. When treatment is needed, it can include radiation therapy, laser therapy, photodynamic therapy or surgery. Targeted therapy and immunotherapy may be used to treat eye melanoma in some situations.

Which treatment is best for eye melanoma depends on several factors. These factors include the size and location of the cancer. Treatment also depends on whether cancer has spread beyond the eye. Your overall health and what you prefer to do is part of treatment planning too.

Waiting to treat small eye melanomas

A small eye melanoma may not need to be treated right away. If the melanoma is small and isn't growing, you and your healthcare professional might choose to wait and watch for signs of growth.

If the melanoma grows or causes other health concerns, you may choose to have treatment at that time.

Radiation therapy for eye melanoma

Radiation therapy treats cancer with powerful energy. Radiation therapy is typically used for small to medium-sized eye melanomas.

For eye melanoma, radiation therapy often involves placing a radioactive device on the eye. The device is called a plaque. It looks like a bottle cap. The plaque holds several radioactive seeds. A healthcare professional places the plaque on the eye, over the cancer. The plaque is held in place with temporary stitches. The plaque stays in place for a few days. Then it's removed. Radiation treatment that involves putting the radiation inside the body is called brachytherapy.

The radiation also can come from a machine that aims beams of radiation, such as proton beams. The beams can be aimed at the eye to treat eye melanoma. Giving radiation with a machine outside the body is called external beam radiation. This type of radiation therapy often is given over several days.

Laser therapy for eye melanoma

Laser therapy uses a laser light to hurt the cancer cells. For eye melanoma, it might be used in some situations. One type of laser treatment, called thermotherapy, uses an infrared laser. It's sometimes used along with radiation therapy to treat eye melanoma.

Photodynamic therapy for eye melanoma

Photodynamic therapy is a two-stage treatment that combines light energy with a medicine called a photosensitizer. The photosensitizer kills cancerous and precancerous cells when activated by light, usually from a laser. For eye melanoma, photodynamic therapy is used for smaller cancers.

Surgery for eye melanoma

Surgery to treat eye melanoma may involve removing the melanoma or removing the entire eye.

• Surgery to remove the melanoma. Surgery to remove the melanoma and a band of healthy tissue around it may be an option for treating some small eye melanomas.

• Surgery to remove the eye. Surgery to remove an eye is called enucleation. It may be used for some large eye melanomas.

  After the eye with melanoma is removed, an implant often is put into the same place. The muscles that control the movement of the eye are attached to the implant. That allows the implant to move. After the eye has time to heal, an artificial eye, called a prosthesis, is made that matches the other eye.

Targeted therapy for eye melanoma

Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die. For eye melanoma, targeted therapy may be used when the cancer has spread to other parts of the body or in situations where surgery isn't possible.

Immunotherapy for eye melanoma

Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells. For eye melanoma, immunotherapy may be used when the cancer has spread to other parts of the body or in situations where surgery isn't possible.

Coping and support

Coping with vision changes

If cancer treatment causes total loss of vision in one eye, it's still possible to do most things you were able to do when you could see with both eyes. But it may take several months to get used to the new way of seeing.

Having only one eye affects the ability to judge distance. And it may be harder to be aware of things around you. That's especially true of things that happen on the side where you no longer have vision.

An occupational therapist can help you learn ways to cope with a change in vision. A support group also may be helpful. Ask your healthcare professional for recommendations.

Preparing for an appointment

Start by seeing your primary healthcare professional if you have any symptoms that worry you. If your healthcare professional suspects you have an eye problem, you may be referred to a doctor who specializes in eye care, called an ophthalmologist.

If you have eye melanoma, you may be referred to a doctor who specializes in eye cancer, called an ocular oncologist. This doctor can explain your treatment options and may refer you to other specialists depending on the treatments you choose.

Appointments may be short, so it's a good idea to be prepared. Here's some information to help you get ready.

What you can do

• Be aware of anything you need to do before your appointment. When you make the appointment, ask if there's anything you need to do to get ready.
• Write down any symptoms you have. Include any that may not seem related to the reason why you scheduled the appointment.
• Write down key personal information. Include any major stresses or recent life changes. Family medical history also can be helpful.
• Make a list of all medicines, vitamins or supplements that you take.
• Consider taking a family member or friend along. Sometimes it can be hard to remember all the information you get during an appointment. Someone who comes with you may remember something that you missed or forgot.
• Write down questions to ask your healthcare professional.

Bringing a list of questions to your appointment can help you make the most of the time with your healthcare professional. For eye melanoma, some basic questions to ask include:

• Do I have eye melanoma?
• Where is the eye melanoma located?
• What is the size of the eye melanoma?
• Has the eye melanoma spread beyond my eye?
• Will I need additional tests?
• What are my treatment options?
• Can treatments cure the eye melanoma?
• What are the potential side effects of each treatment?
• Do I have to have treatment?
• How long can I take to decide on a treatment?
• Is there one treatment you feel is best for me?
• How will treatment affect my daily life?
• How will treatment affect my vision?
• I have other health conditions. How can I best manage them along with eye melanoma?
• Should I see other specialists?
• Are there brochures or other printed material that I can take with me? What websites do you recommend?

Don't hesitate to ask other questions you may have too.

What to expect from your doctor

Your healthcare professional is likely to ask you some questions, including:

• When did you start having symptoms?
• Do you have symptoms all the time, or do they come and go?