Choroidal melanoma is a cancer of the eye that develops in a part of the eye called the choroid, the spongelike membrane that lies between the sclera (the white of the eye) and the retina. The choroid is rich in blood vessels and supplies nutrients to the retina, the light-sensitive back of the eye that sends visual information to the brain. Although choroidal melanoma is a rare form of cancer, it is the most common cancer that develops in the eye in adults.

Over time, many choroidal melanomas enlarge and cause the retina to detach, which can lead to vision loss. The tumors also can spread (metastasize) to other parts of the body and cause death. Choroidal melanomas most commonly spread to the liver. According to the U.S. National Institutes of Health (NIH), 1,680 to 2,240 new cases of this cancer are diagnosed each year in the United States and Canada, which is about six or seven new cases per million people each year. It usually occurs in people who are middle-aged or older.

This cancer often doesn't cause any symptoms in its early stages, so the tumor may grow for some time before the problem becomes noticeable. When symptoms occur, they include blurred vision, floaters, flashing lights, or severe eye pain. These symptoms also can be caused by many other, more common, noncancerous causes.

Most cases of choroidal melanoma are detected during a routine, dilated eye exam, in which an ophthalmologist dilates the pupils to examine the back of the eye. Most of the time, no other tests are needed. Specialized tests can help make the diagnosis more certain. They include:

• Echography — A small probe placed on the eye, directs sound waves toward the tumor and records the pattern as the waves reflect off the tumor.



• Fluorescein angiography — A fluorescent dye is injected into a vein in the arm, and a rapid sequence of photographs is taken through the pupil as the dye passes through the veins in the back of the eye.

Once it develops, choroidal melanoma often will continue to grow unless it is treated. Treatment is recommended if findings indicate that the tumor is likely to enlarge and cause loss of vision, or possibly spread to other organs.

The causes of choroidal melanoma are not well understood so there is no way to prevent it.

Management and treatment of choroidal melanoma will depend on the size of the tumor. If the choroidal melanoma is small, often nothing is done and the tumor is monitored. Treatment is started if the melanoma grows.

Medium and large choroidal melanomas usually are treated with radiation or surgery. Radiation therapy may be administered by several methods. Local radiotherapy is delivered via a small, metal, dish-shaped device that contains radioactive iodine. The device is stitched to the sclera so that the radiation can target the tumor precisely. In some institutions the radiation may be delivered by an external beam of radiation. In some cases, the eye has to be removed by surgery. Most ophthalmologists recommend removal of the eye for large choroidal melanomas. After the eye is removed, a prosthetic eye is placed into the socket. Cosmetically, the fake eye can look good, but it often does not move as well as a natural eye.

If you are treated for choroidal melanoma, you will need to be monitored for the rest of your life to detect early signs of the cancer spreading. Doctors disagree whether choroidal melanoma should be treated if it already has spread by the time the cancer is diagnosed. There is little clinical evidence that radiation or surgery to remove the eye affects the outcome at all in these cases. Researchers are continuing to investigate whether chemotherapy and immunotherapy treatments after the eye is removed can reduce the risk of death from choroidal melanoma that has spread.

Visit your doctor for a complete eye examination if you experience changes in your vision. You should call your doctor right away whenever you have blurred vision, floaters, flashing lights, or severe pain in or around your eye or if you experience any loss of vision. You may need to be seen immediately in the office or in an emergency room.

The outlook depends on the size of the tumor at the time of diagnosis. The prognosis is better if the cancer is detected early.

National Eye Institute
2020 Vision Place
Bethesda, MD 20892-3655
Phone: 301-496-5248
http://www.nei.nih.gov/

National Cancer Institute (NCI)
U.S. National Institutes of Health
Public Inquiries Office
Building 31, Room 10A03
31 Center Drive, MSC 8322
Bethesda, MD 20892-2580
Phone: (301) 435-3848
Toll-Free: (800) 422-6237
TTY: (800) 332-8615
E-Mail: cancergovstaff@mail.nih.gov
http://www.nci.nih.gov/