Melanoma: Diagnosis & Treatment of Ocular Melanoma

Pictured: David Abramson David Abramson is Chief of Memorial Sloan Kettering's Ophthalmic Oncology Service, the only service of its kind in a United States cancer hospital.

For many people, an ophthalmologist conducting a routine eye examination is the first to detect melanoma in the eye. But because this condition is so rare, most ophthalmologists see only a few cases of eye melanoma over the course of their careers, and it’s commonly misdiagnosed.

In contrast, each year Memorial Sloan Kettering ophthalmic oncologists find more than 200 cases of choroidal nevi (which can grow into malignant melanomas) and treat approximately 60 people with new eye melanomas.

Diagnosis

To confirm a diagnosis of eye melanoma, we perform a complete ophthalmic exam and review and may order our own diagnostic imaging tests. These may include:

  • Digital imaging. This enables us to visualize the tissues of the eye as well as circulation. We use advanced methods such as autofluorescent photography and fluorescein angiography to enhance image details.
  • Ultrasound imaging. This approach — also called high-frequency one- and two-dimensional ultrasound imaging or A and B scan ultrasonography — provides another way of examining areas of the eye that contain possible tumors.
  • Optical coherence tomography. This allows us to map eye tissues using reflected light, visualizing tumors in yet another manner.

Surgery & Other Treatment Approaches

Our experts have decades of experience using brachytherapy, a form of radiation in which radioactive material is surgically placed on the outside wall of the eye corresponding to the tumor on the inside of the eye. Most people can be treated with this approach. 

Prospective randomized trials sponsored by the National Institutes of Health, in which MSK played a leadership role, have proven that removal of the eye and brachytherapy are equally effective for survival in people with medium-size tumors. 

However, depending on the size, location, and stage of the tumor, we may recommend that you have an operation to remove the eye. We often suggest this approach, called enucleation, for people with relatively large eye melanomas. If the tumor is small, we may be able to treat it effectively with laser therapy.

Follow-up Care

After being treated for ocular melanoma we typically recommend that you visit us twice a year for eye examinations and may recommend periodic scans and blood tests to check for signs of disease in the rest of your body.

Treating Metastatic Ocular Melanoma

If melanoma spreads beyond the eye to other parts of the body, you may need systemic treatment (treatment throughout the body). While there’s no standard systemic treatment known to be effective in uveal melanoma, we have several clinical trials under way to test immunotherapy approaches.