Ocular melanoma: treatments for primary tumors

Ocular melanoma treatment varies depending on whether the cancer in the eye started there - or spread from another part of the body. 

Ocular melanoma that started in the eye is known as ‘primary’ ocular melanoma.

Meanwhile, ocular melanoma that originally started in another part of the body before spreading to the eye is called ‘secondary’ ocular melanoma.

This article is focused on treatments for primary ocular melanoma.

The actual treatment used will depend on several factors. The most important is the size of the tumor.

On that note, treatment options fall into two main categories: radiation therapies and surgical therapies.

Radiation therapies

1. Brachytherapy

Brachytherapy is a form of radiation therapy. It involves using a small bowl-shaped device containing radioactive ‘seeds’.

To function, the device is placed on the surface of the eye over the tumor. The radiation in the seeds is then directed at the tumor.

The disk is typically removed within seven days. And the tumor shrinks over the next two to three months.

Because this therapy avoids harming healthy tissue surrounding the tumor, it allows the eye to be preserved and the retention of some visual function. It also avoids cosmetic disfiguration.

2. Teletherapy

This involves directing a column of radiation through the front of the eye. It is typically used when the ocular melanoma is touching or surrounding the optic nerve.

Surgical therapies

1. Iridectomy

When parts of the iris contain small ocular melanomas which haven’t spread to other areas of the eye, they may be removed using this procedure.

2. Iridotrabeculectomy

If ocular melanomas are present in the iris and they’ve spread to the supporting tissue, this procedure may be used. It involves removing the tumors from both areas.

3. Iridocyclectomy

The ciliary body is a thin, middle layer of the eye, situated between the white of the eye (sclera) and the retina. In this procedure, part of the iris and ciliary body are removed.

4. Choroidectomy

This involves removing part of the choroid – and potentially part of the wall of the eye too. It may be followed-up by radiation therapy.

5. Enucleation

Enucleation involves removing the whole eye. It is typically used when removing large ocular tumors. For cosmetic purposes, the original eye is replaced with an artificial one called an ‘ocular prosthesis’.

Ocular melanoma treatments continue to evolve. To help speed this process, people with ocular melanoma often consider participating in a clinical trial.