Choroidal melanoma is the most common primary intraocular (occurring inside the eye) tumor in adults. It arises from the pigmented cells of the choroid of the eye and is not a tumor that started somewhere else and spread to the eye. A choroidal melanoma is malignant, meaning that the cancer may metastasize and eventually spread to other parts of the body. Since choroidal melanoma is inside the eye and not usually visible, patients with this disease often do not recognize its presence until the tumor grows to a size that impairs vision by obstruction, retinal detachment, hemorrhage, or other complication. Pain is unusual, except occasionally with large tumors. Periodic retinal examination through a dilated pupil is the best means of early detection.
Treatment recommendations for choroidal melanoma usually are based on the size of the tumor. Small lesions suspicious for melanomas usually are closely watched for evidence of growth before treatment is recommended. Medium-sized tumors may be treated with either radioactive plaque therapy or enucleation (removal) of the eye. The Collaborative Ocular Melanoma Study (COMS), supported by the National Eye Institute of the National Institutes of Health, has documented equal success rates for plaque radiation therapy or enucleation for preventing the spread of cancer. Large-size tumors usually are often treated by removing the eye (enucleation) because the amount of radiation required to treat the tumor is too much for the eye to tolerate. The COMS study found no benefit to large-size tumor patients having radiation therapy prior to enucleation. Recent advances have improved radiation therapy for all melanoma tumor types including small, medium and large ocular melanoma.
Patients with choroidal melanoma undergoing evaluation and treatment at the Bascom Palmer Eye Institute have access to the most advanced diagnostic imaging testing and treatment modalities available currently in the United States with an accuracy of diagnosis that has exceeded 99% in evaluation of complex ocular malignancies, utilizing this advanced technology. We have an ongoing focus on the eradication of intraocular tumor associated with conserving the eye. This treatment approach allows the patient to maintain their eye with visual function in the setting of definitive treatment for their melanoma. Advanced treatment options include focused radiotherapy, laser hyperthermia, combined application treatments including radiotherapy, hyperthermia, and surgical resection; all are options for patients for treatment at the Bascom Palmer Eye Institute.