Eye Cancer (Melanoma and Lymphoma)

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Treating Eye Cancer TOPICS

Treating uveal (eye) melanoma by location and size

The main factors in determining treatment for eye melanoma include the location and size of the cancer, as well as the likelihood of saving vision in the eye. There is not much advantage in saving an eye if a small melanoma in a crucial place has completely destroyed vision. And doctors will not necessarily want to remove an eye that functions normally even if the tumor is large. Therefore, the statements below about treatment are only general and may not apply to every situation.

It is important to keep in mind that both outcomes and quality of life tend to be similar over time in patients who have had enucleation (removal of the eyeball) and those who have had radiation therapy. Radiation therapy is more likely to preserve some vision in the eye, especially during the first few years after treatment, but studies have found that people who have had radiation therapy are also more likely to be anxious about the chance of the cancer coming back. Be sure to talk with your doctor before treatment about what factors are most important to you.

Choroidal melanomas

Treating these cancers depends on their size and how well the eye functions. The smaller the tumor, the less likely surgery will be needed, unless the eye is badly damaged or vision is lost.

Small melanomas: There are often several options for treating small choroidal melanomas. Both you and your doctor should decide which option is best for you.

  • Careful observation (also known as watchful waiting). Not all melanomas grow quickly and need to be treated right away. If the tumor is very small, watching for some time and only treating if it starts to grow is often a reasonable option.
  • Radiation therapy, such as brachytherapy, proton beam therapy, or stereotactic radiation therapy
  • Laser therapy, including transpupillary thermotherapy (TTT)
  • Surgery, which may require removing only the tumor or may need to be as extensive as enucleation (removing the entire eye). This may be necessary if the eye is severely damaged by the tumor (for example, causing severe glaucoma).

Medium-sized melanomas: These tumors can usually be treated by most approaches listed above with the exception of laser therapy or TTT (although TTT might be used after radiation). Once again, the choice of treatment is a decision that should be made by both you and your doctor. Radiation and surgery appear to be about equally effective. Radiation offers the best chance of preserving vision in the eye, but some people who have radiation may eventually need surgery.

Large melanomas: The standard treatment for these cancers is surgery, which often needs to be more extensive than for smaller melanomas. Enucleation (removal of the entire eye) is the preferred surgery. In rare cases where the cancer has grown extensively outside of the eye, the doctor might recommend removing other structures in the eye socket, such as muscles or part of the eyelid, as well.

Some doctors have begun treating large melanomas with plaque radiotherapy with fairly good results. The cure rate appears to be about as high as with surgery, but it is important to have a doctor experienced in using this procedure for large melanomas. This allows patients to avoid the cosmetic effect of losing their eye, but most patients still end up with poor vision in the eye. Other options that may be considered include proton beam radiation and stereotactic radiosurgery.

Melanomas of the iris

Melanomas of the iris are usually small, slow-growing tumors. One option for people with an early stage iris melanoma is to watch it closely to see if it grows. A series of special photographs are taken to help monitor the tumor. If it begins to grow, treatment may be surgery or radiation therapy (in certain situations).

If surgery is recommended, the amount of eye tissue to be removed depends on the extent of the cancer. Types of surgery for early iris melanomas include:

  • Iridectomy (removal of part of the iris)
  • Iridotrabeculectomy (removal of part of the iris, plus a small piece of the outer part of the eyeball)
  • Iridocyclectomy (removal of a portion of the iris and the ciliary body)
  • Enucleation (removal of the eyeball)

Ciliary body melanomas

These cancers can be treated with either surgical removal of the tumor, if it is small enough, or radiation therapy. In more advanced cases or if there is serious eye damage, enucleation may be needed.

Advanced and recurrent melanomas

Most uveal melanomas are found only within the eye when they are first diagnosed. It is rare for the cancer to be found to have already spread outside of the eye. But unfortunately, in about half of all patients the melanoma will come back at some point after treatment.

Cancer that comes back after treatment is called recurrent. Recurrence can be local (in or near the same place it started) or distant (spread to organs such as the lungs or liver).Treating melanomas that come back after the initial treatment depends on several factors, including where the cancer recurs and what type of treatment was used initially.

Cancers that recur within the eye (intraocular recurrence) are usually treated by enucleation.

When melanoma recurs outside of the eye (called extraocular recurrence), it most often comes back as spread to the liver. It might also come back as spread to other areas, like the lungs or bone. These cancers are often hard to treat.

If the cancer is only in the liver, different types of treatments might help keep the cancer under control or help relieve symptoms. These include surgery (if there is only one or a few tumors), radiation therapy, destroying (ablating) tumors by heating or freezing them, or injecting drugs or other substances into the liver. Tumor ablation and radiation might also be used for tumors that have spread to other parts of the body, such as the lungs.

Systemic (whole-body) treatments such as chemotherapy, immunotherapy, and targeted therapy drugs have not yet been proven to be very helpful in treating eye melanomas that have spread, but they might help keep the cancer in check for a time in some people. Because current treatments for advanced eye melanomas are limited, clinical trials of newer treatments might be a good option.

Last Medical Review: 09/13/2013
Last Revised: 02/11/2014