The main factors in determining treatment for eye melanoma include the size and stage of the cancer, as well as the likelihood of saving vision. There is no major 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 can only be general and may not apply to every situation.

It is important to remember that patients who have had enucleation (removal of the eyeball) and those who have had radiation therapy respond similarly when asked about the quality of their lives after treatment. The most important outcome for these people was surviving this cancer.

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.

• radiation therapy, such as brachytherapy, proton beam therapy, or stereotactic radiation therapy)

• laser therapy, including 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).

It is often hard to tell if a small tumor is cancerous, so your doctor may recommend watching the tumor carefully to see if it grows before deciding on a treatment.

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 involve both you and your doctor. Radiation and surgery appear to be about equally effective. Radiation offers the best chance of preserving eyesight, but some people who have radiation may eventually need surgery.

Large melanomas: These cancers are usually treated by surgery, which often needs to be more extensive than for smaller melanomas. Enucleation (removal of the entire eye) is the preferred surgery.

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. This allows patients to avoid the cosmetic effect of losing their eye, but most patients still end up with poor vision in the eye.

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 wait and see if it grows. A series of special photographs are taken to help monitor the tumor. If it begins to grow, treatment may consist of surgery or radiation therapy (in certain situations).

If surgery is recommend, 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 melanoma

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.

Recurrent melanomas

Treating melanomas that recur (come back) after 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. Extraocular recurrences, like skin melanomas that recur at distant sites, are often hard to treat. Immunotherapy (drugs that boost the immune system) and/or chemotherapy are the most commonly used treatments. Surgery may be an option in rare cases if the recurrence is only in one spot. For more detailed information on treating advanced melanomas, see our separate document, Melanoma Skin Cancer.

Last Medical Review: 03/03/2009
Last Revised: 05/14/2009