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Keeping an Eye on Ocular Melanoma

May 16, 2018

Malignant melanoma of the eye – ocular melanoma – is rare. But there are common precursors of the disease. Dr. Scott Walter from the Hartford HealthCare Cancer Institute’s Melanoma and Skin Cancer Center is one of only two ocular oncologists practicing in Connecticut.  

Q: What is ocular melanoma?

A: Ocular melanoma is the most common form of cancer that originates in the eye. Like skin melanoma, ocular melanoma arises from darkly pigmented cells called melanocytes; but the similarities end there. Unlike skin melanoma, most ocular melanomas are not related to sun or UV light exposure. The genetic mutations responsible for skin and eye melanoma are also different, as are the approaches to treating the disease.

Q:  How common is it?

A: Ocular melanoma is much rarer than skin melanoma. There are only about 2500 cases diagnosed per year in the United States, and approximately 20-30 new cases per year here in the state of Connecticut. However, the precursor to ocular melanoma (known as  choroidal nevus) is much more common. Approximately 1 in 10 Causasians have a choroidal nevus, or mole under the retina. Most of these are benign, but sometimes it can be difficult to distinguish a suspicious-looking mole from a small melanoma.

Q: What are the symptoms?

A: If the tumor grows large enough, it can cause a localized detachment of the retina around the tumor, which can interfere with central or peripheral vision. Sometimes patients may experience flashes and floaters. But most patients with a choroidal nevus or small ocular melanoma have no symptoms whatsoever. The condition is often recognized as an incidental findings on a routine eye exam. Therefore, having an annual dilated eye exam and/or pictures taken of the back of the eye increases the chances of detecting this condition early.

Q: What treatments are available?

A: For many years, the only treatment option was eye removal. Nowadays, most small- to medium-sized ocular melanomas can be treated with laser, radiation, or a combination of the two. The radiation treatment involves two procedures to place and remove a radioactive implant, and the patient stays in the hospital for a few days while the implant is in place. For very large melanomas with little or no vision left in the eye, it is still sometimes necessary to remove the eye in order to save the patient’s life. Unfortunately, there is still no cure for ocular melanoma once it spreads from the eye to other parts of the body. But together with researchers from Memorial Sloan Kettering and other institutions, we are working hard to find a cure.

Get more information about the Hartford HealthCare Cancer Institute’s Melanoma and Skin Cancer Center.