The wall of the eye has 3 main layers. From outside to inside there is: the white sclera, a blood vessel layer called the uvea (choroid, ciliary body and iris) and an inner retinal layer. Further, the pigment producing cells, “melanocytes” are primarily found in the vascular uveal layer. It is those melanocytes that can turn into malignant melanoma. Therefore, when melanoma happens in the choroid, they are called “choroidal melanoma,” the most common primary intraocular malignancy in adults. That said, choroidal melanomas are rare with 5 to10 out of each million people diagnosed with a choroidal melanoma each year. Choroidal melanomas can spread to other parts of the body.

Symptoms of Choroidal Melanoma

Most choroidal melanoma patients have no symptoms. The melanoma is found on routine eye examination. If patients have choroidal melanoma symptoms, they are usually seeing “flashes of light,” noticing “distortion” or loss of vision, and floating objects (floaters) in their vision.

1. If the choroidal melanoma is in the front of the eye (near the natural lens), it can push or tilt the natural lens causing an irregular astigmatism (blurring of vision).
2. Choroidal melanoma can leak fluid beneath the retina, making the retina detach and cause symptoms of flashing lights and floating specks “floaters”.
3. If the choroidal melanoma is in the macula (center of vision), it can grow beneath the fovea making the patient far-sighted. The choroidal melanoma can also grow into and destroy the fovea causing distortion, loss of vision or changes in color perception.

Diagnosis of Choroidal Melanoma

Most cases of choroidal melanoma are detected during a routine, dilated eye exam. During this exam, an eye specialist (ophthalmologist) dilates the pupils to examine the back of the eye. Most of the time, no other tests are needed. But specialized tests can confirm the diagnosis. These tests include

• Ultrasound. A small probe placed on the eye directs sound waves toward the tumor. A machine records the patterns the waves make as they bounce off the tumor.
• Fluorescein angiography. A fluorescent dye is injected into an arm vein. A rapid sequence of photographs is taken through the pupil as the dye passes through the veins in the back of the eye.

After a choroidal melanoma has been diagnosed, an MRI (magnetic resonance imaging) scan may be ordered. This can help doctors further evaluate the tumor's characteristics.

Treatments of Choroidal Melanoma

Management and treatment of choroidal melanoma depends on the tumor's size. If the tumor is small, it may simply be monitored. If it grows, treatment would start.

Medium and large choroidal melanomas usually are treated with radiation or surgery. Radiation therapy may be given in different ways. Local radiation is delivered via a small, metal, dish-shaped device containing radioactive iodine. The device is stitched to the sclera so that the radiation can target the tumor precisely. In some institutions, external beam radiation therapy may be used. Beams of radiation target the tumor from outside the body.

In some cases, the eye has to be removed. This is called enucleation. Most ophthalmologists recommend removing the eye if the choroidal melanoma is large. After the eye is removed, a prosthetic eye is placed into the socket. Cosmetically, the fake eye can look almost real. However, it often does not move as well as a natural eye.

Treatment of choroidal melanoma that has already spread beyond the eye has had very limited success. There is little evidence that radiation or surgery to remove the eye affects the outcome in these cases. Researchers are studying whether chemotherapy given after the eye is removed can reduce the risk of death from metastatic choroidal melanoma. Newer biological therapies are also being tested.

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Sarah Rose

Journal Manager Journal of Eye Diseases and Disorders

Email: eyedisorders@emedsci.com

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