Ocular melanomas can develop out of any pigmented cell (also known as a “melanocyte”) within the eye and most of these pigmented cells reside in the three layers that comprise the “uveal tract”.
The uvea or uveal tract has three parts:
- The iris - which is the colored part of the eye that surrounds the dark pupil
- The ciliary body - which sits behind the iris and makes most of the fluid that circulates inside the eye
- The choroid - which is a thin layer of mostly blood vessels that sits in between the retina (the seeing part of the eye) and the sclera (the white of the eye) in the back of the eye
The term “ocular melanoma” covers cancers that develop out of pigmented cells in any of those locations, but in most cases, a more precise term like conjunctival, iris or choroidal melanoma is used to denote the location of origin. Melanomas that arise from each of these locations behave very differently, and very differently from those that occur on the skin.
Though surgery may be performed in certain circumstances to remove melanomas the majority of uveal melanomas are treated with radiation therapy as most choroidal melanomas are not amenable to surgical removal. There are several methods for delivering the radiation to the eye.
- Plaque brachytherapy is the most common method employed. Involves a surgical procedure performed in the operating room in which a metal disc is sutured (sewn) on the outside white of the eye (sclera), directly underneath the melanoma. The disc is custom made for each eye. There is shielding on all sides of the plaque but the bottom which means that very little radiation is directed outside the eye. The plaque stays in place for 3-5 days, and then is removed surgically. At that point the treatment is done and no residual radiation exists. At the New England Eye Center at Tufts Medical Center, most uveal melanomas are treated with a plaque.
- The Gamma Knife can be used to treat melanomas as well. Originally developed to treat brain tumors, the ophthalmologists, radiation oncologists, and neurosurgeons at Tufts Medical Center have been using Gamma Knife radiosurgery for certain ocular melanomas for over 15 years. The Gamma Knife treatment is a highly effective one day, non-surgical outpatient procedure.
- Proton beam irradiation can be used to treat melanomas as well. This technique involves a surgical procedure to place metal clips on the white of the eye in order to locate the melanoma for the subsequent therapy. The radiation is then delivered in about 5 sessions over a 10 day period.
- Enucleation is the surgical removal of the eyeball. It is usually employed for melanomas if there is no useful vision in the eye or under the rare circumstances that a prior radiation therapy has failed or produced significant side effects.
- Laser treatment as primary therapy for melanoma is not typically employed as primary treatment but is occasionally used as adjunctive treatment after radiation in certain cases.
Nearly all tumors can be controlled locally within the eye using radiation therapy.
What makes the Ocular Oncology Service at Tufts Medical Center special?
Experience – Drs. Duker and Mignano have over two decades of experience treating choroidal melanoma.
Options – Tufts Medical Center provides several options for choroidal melanoma therapy. We individualize the therapy for each patient.
Access to specialists if needed – We are a full service hospital that provides the highest quality of eye care and oncologic care for our patients under one roof.