Ocular melanoma: Saving lives, saving eyes

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CLEVELAND, Ohio (Ivanhoe Newswire) –Ocular melanoma, also called uveal melanoma, is a type of melanoma that targets the eye. It affects about 2,000 people a year in the United States. Although rare – it can be a deadly if it isn’t spotted early enough. Now, there’s a way to treat patients that’s saving lives and saving eyes.

Sally Martin knits every day.

“I make sweaters, vests, a lot of mittens and hats,” Martin told Ivanhoe.

But when she started losing vision in her right eye – her hobby became more difficult.

“I thought it was related to being over 50 and you lose some close-up vision,” Martin said.

Martin found out it was something much more serious – uveal melanoma.

“It is not a minor or an insignificant kind of cancer,” Arun Singh, MD, Director of Ophthalmic Oncology, Cole Eye Institute and Taussing Cancer Center, The Cleveland Clinic, told Ivanhoe.

Patients with eye melanomas that have spread only have a 15 percent survival rate.

Martin’s doctor caught hers before it spread, so she was a candidate for a type of radiation known as brachytherapy. This gold disc was stitched directly on Martin’s eye.

“They are seeds within a disc like a radioactive button,” Dr. Singh said.

Martin wore the disc for three days in the hospital. During that time, the radioactive seeds targeted the cancer. She still has a blind spot in her right eye, but she’s happy to be cancer-free.

“I feel very fortunate that it was caught early, and that my prognosis is very good,” Martin explained.

Now, she can focus on making more of her favorite things.

The method has a 95 percent success rate for patients whose tumors haven’t spread. Some patients do not have any symptoms when they have melanoma of the eye. It depends on where the tumor is located. These patients typically do not catch the cancer until it has already spread. It spreads to other organs in the body in about half of all cases.

BACKGROUND: Ocular melanoma, also known as uveal melanoma or choroidal melanoma, is an eye cancer diagnosed in about 2,000 adults every year in the United States. Like other melanomas, ocular melanoma starts in melanocytes, the cells which color the eye. It can involve any three areas of the eye: the iris, ciliary body, or the choroid. The iris is the colored part of the eye, which opens and closes to allow more or less light into the eye. The ciliary body is an eye muscle which controls the focus of the eye. And the choroid is a layer of tissue where pictures are projected. Those with iris melanomas generally have the best prognosis, and those with ciliary generally have the worst, even though it is the most common form of the disease. (Source: Melanoma Research Foundation)

CAUSES: Ocular melanoma tumors come from pigment cells that give color to the eyes. These types of cells, which also color skin and hair, are also responsible for forming moles. The exact cause is unknown. But it is known that exposure to ultraviolet rays, or UV rays, increases the risk of developing melanoma of the skin. People with fair skin, red hair, and blue eyes are at the greatest risk for developing it. Ocular Melanoma may be more common in those with atypical mole syndrome. This means they are at greater risk of developing melanoma of the skin and have over 100 moles on their body, some of which are abnormal in size. (Source: occularmelanoma.org)

NEW TECHNOLOGY: Brachytherapy or internal radiation can treat ocular melanoma using a small disc shape shield. The shield can contain Iodine-125 or Palladiu,-103, two radioactive properties. The shield is attached to the outside surface of the eye and is left on the eye for a few days. The radioactive seeds go after the cancer. The treatment has a 95 percent success rate for patients whose tumors haven't spread. Brachytherapy may cause fewer side effects than external beam radiation and the treatment time is usually shorter. According to a JAMA study patients treated with brachytherapy had better vision when it came to driving and peripheral vision for up to 2 years following the treatment compared to enucleation, a surgical procedure involving removing part of the eye. (Sources: JAMA, Mayo Clinic)

Arun D. Singh, M.D., Director of Ophthalmic Oncology in the Cole Eye Institute at Cleveland Clinic, talks about treatment of ocular melanoma.

Are there numerous types of eye cancers?

Dr. Singh: Yes, the cancers can arise from the surface of the eye. They can arise from inside of the eye or they could arise from outside the eye (breast cancer or lung cancer) and they can travel to the eye.

Often these melanoma of the eye don’t have any specific symptoms, right?

Dr. Singh: It depends upon the location and the size of the tumor. If they are small tumors away from the central part of the vision there may be no symptoms whatsoever. We have had patients that have gone for Lasik examinations, for routine examinations, that had melanoma diagnosed on dilated eye exams. But the symptoms are usually present if the tumors are larger or located near the vision area.

What are the visual symptoms and will these eventually cause blindness?

Dr. Singh: Symptoms are very non-specific, so there’s nothing particular such as blurry vision, shadow in the vision or flashing lights. Such symptoms are more often due to other common conditions things

Can you cure this type of cancer?

Dr. Singh: We can achieve excellent local control and there are newer methods being explored to manage the risk from metastasis.

How are radiation seed applied to the tumor?

Dr. Singh: The radiation seeds are within a disk, like a radioactive button. It is stitched to the eyeball exactly where the tumor is during a surgical procedure. The disc is placed for 72 to 84 hours (depending upon individual calculations) so as to deliver full dose of radiation. After the radiation disc is removed, the eye usually heals very well.

Any risks with radiation?

Dr. Singh: Although the radiation is focused on the tumor, retina and the optic nerve in the vicinity of the tumor also get exposed to radiation. There is a risk of vision loss from the radiation. But there are no complications outside the eye from this radiation. It’s only limited to where you put the radiation.

With these melanomas of the eye is it really important to detect them early? And does it spread fast?

Dr. Singh: Yes, it makes sense always to detect tumors early when they are small.

Is there a size limit on the tumor for the treatment?

Dr. Singh: Yes, generally speaking, the tumors should be less than 16mm in base and not more than 10 mm in height for radiation therapy. That’s the usual traditional criteria. If larger, removal of the eye is generally recommended