Uveal Melanomas

Uveal (choroidal) melanomas are the most common primary malignant intraocular tumor in adults with an annual incidence of 6 cases per million per year. They can affect the iris, the ciliary body or (most commonly) the choroid (a vascular layer deep to the retina).

Symptoms and signs:
Choroidal melanomas may be completely asymptomatic at the time of diagnosis or may be associated with visual loss or flashes and floaters.

Diagnosis:
The diagnosis of uveal melanoma is made with clinical examination using an indirect ophthalmoscope and judicious use of ancillary studies such as fluorescein angiography and ultrasonography.

Treatment Options:
Enucleation (removal of the eye leaving the ocular adnexal structures including the extraocular muscles intact) is an option, particularly for larger tumors. Radioactive plaques are also an alternative for small to medium sized tumors. The use of some forms of laser or proton beam therapy may also be indicated in some cases.

Long-term prognosis:
It is recommended that patients with uveal melanomas, regardless of their local treatment modality, be monitored frequently to look for evidence of local recurrence or distant metastasis. It is estimated that 20-50% of patients develop distant metastasis (usually to the liver) in their lifetime.

Research endeavors:
M.D. Anderson is conducting studies dealing with serologic tumor markers for detection of early metastasis in uveal melanomas and genetic and molecular characteristics of individual tumors that may predict outcome.

The Melanoma Medical Oncology Department at M.D. Anderson is currently recruiting patients with metastatic choroidal melanomas to participate in several clinical trials available within that department.

For more information or to schedule an appointment, please call (713) 794-1247 or the new patient referral line: 1 (800)392-1611.

II. Conjunctival Melanomas:
The conjunctiva is a mucous membrane lining the entire eyelid skin as well as the globe (eye ball). Conjunctival melanomas are very rare tumors with an estimated incidence of less than 1 per million per year

Symptoms and Signs:
Conjunctival melanomas usually present as a pigmented (dark ) area on the conjunctiva that is usually acquired or may develop from a nevus. Any pigmented lesion on the conjunctiva that grows or is acquired should be biopsied to rule out malignant melanoma, especially in the white population.

Treatment Options: Once the diagnosis is established via a biopsy, the local treatment consists of wide excision of the involved area supplemented by cryotherapy. Consideration should be given to sentinel lymph node mapping and biopsy to identify patients with occult lymph node metastasis as early as possible.

Long-term prognosis:
Unfortunately conjunctival melanomas have a tendency to recur locally (on the surface of the eye) and often require multiple resections. Up to 40% of patients may ultimately develop regional lymph node involvement (usually in the parotid and neck area) and distant metastasis can occur in up to 50% with long-term follow-up. Once distant metastasis occurs, treatment options include conventional chemotherapy or biochemotherapy.

Research Protocols Available at M.D.Anderson:
M.D. Anderson is currently enrolling patients with primary or recurrent conjunctival melanoma without clinical evidence of regional or distant metastasis in a study which looks at the role of sentinel lymph node mapping and biopsy for these tumors. Identification of patients who may harbor occult lymph node metastasis via this technique can lead to earlier initiation of adjuvant biochemotherapy and potentially longer survival.

For more information or to schedule an appointment, please call (713) 794-1247 or the new patient referral line: 1 (800) 392-1611.