Choroidal melanoma is the most common primary eye cancer in adults, though it remains rare. Early detection is vital for effective treatment and preserving vision.
A choroidal melanoma is a rare, yet serious, cancer that forms in the choroid—a layer of tissue rich in blood vessels and pigment that lies beneath the retina at the back of the eye. This condition is the most common primary eye cancer in adults, even though it occurs in only about 4 to 6 people per million in the United States each year. Early detection and treatment can make a significant difference in managing this condition, which makes understanding it so important.
Choroidal melanoma develops when malignant tumor cells form from the pigment-producing cells known as melanocytes found within the choroid. Despite being the most common site for melanoma inside the eye, choroidal melanoma remains exceedingly rare overall. The tumor itself typically appears as a dome-shaped dark mass under the retina and can, if left untreated, lead to vision loss or even life-threatening complications if it spreads outside the eye.
To understand choroidal melanoma, it helps to know a bit about eye anatomy. The eye is composed of three main layers:
The choroid is a part of the uvea and is responsible for supplying oxygen and nutrients to the retina. When melanocytes within this richly vascularized layer become cancerous, a choroidal melanoma develops, making the health of the choroid essential to overall vision and eye integrity.
In the landscape of eye conditions, choroidal melanoma stands out due to its rarity. With only about 4 to 6 new cases per million individuals each year in the United States, it is not something most people will experience. That said, certain factors may elevate an individual's risk:
It is important to remember that having one or more risk factors does not guarantee that someone will develop choroidal melanoma, but staying informed and undergoing regular eye examinations is critical, especially for those who fall into higher-risk groups.
One of the challenges with choroidal melanoma is that it often remains asymptomatic until it reaches a more advanced stage. When symptoms do emerge, they typically occur as the tumor grows larger and begins to impact vision. Here are some signs you need to be aware of:
Because nearly 30% of cases are discovered during routine eye examinations even when no symptoms are present, regular check-ups serve as a crucial tool for early detection. If you notice any changes in your vision, it is essential to contact our eye doctors to discuss further evaluation.
The diagnosis of choroidal melanoma relies heavily on a carefully conducted eye examination and specialized imaging tests. When our eye doctors suspect a tumor, they will begin with a thorough review of your medical history to understand any potential risk factors. Following this, a dilated fundus examination is performed, where the pupils are widened, allowing a detailed look inside the eye.
Here’s the thing: imaging plays a pivotal role in confirming the diagnosis. The following tests are commonly used:
One helpful method our eye doctors use during the exam is the "MOST" mnemonic, which stands for Melanoma, Orange Pigment, Subretinal Fluid, and Tumor Thickness. Here’s what each component means:
These diagnostic tests allow our eye doctors to identify choroidal melanoma with a high degree of accuracy—often eliminating the need for a biopsy.
Given the accuracy of imaging tests and comprehensive eye examinations, most cases of choroidal melanoma are diagnosed without the need for a biopsy. However, there are specific scenarios where a biopsy might be recommended:
While performing a biopsy is generally safe, it does come with certain risks such as bleeding, infection, retinal detachment, or (in very rare situations) tumor seeding where tumor cells spread outside the eye. Before proceeding with a biopsy, our eye doctors will carefully discuss the potential benefits and risks with you so that you can make an informed decision.
These days, many centers perform genetic testing on tumor samples after a biopsy. The goal is to understand the tumor’s genetic makeup, which can help predict its behavior. Specifically, genetic testing may reveal the risk of the melanoma spreading to other parts of the body. This information is useful in crafting a personalized plan for observation and future treatment decisions.
It is important to note that even if a tumor has a favorable genetic profile suggestive of low risk, careful observation and regular follow-ups remain essential. Genetic testing supplements—but does not replace—ongoing monitoring and treatment efforts.
After a diagnosis of choroidal melanoma, one of the primary goals is to control the tumor while preserving as much vision as possible. The treatment plan will depend on the size, location, and overall characteristics of the tumor, as well as your general health. Here are the main treatment pathways that our eye doctors may consider:
Radiation therapy is a common treatment choice for small to medium-sized tumors. The two principal methods include plaque brachytherapy and proton beam therapy. In plaque brachytherapy, a small radioactive disc is placed close to the tumor, targeting the cancerous cells while preserving the surrounding healthy tissue. Proton beam therapy works by directing targeted radiation with high precision.
One thing to keep in mind is that while radiation therapy aims to preserve the eye, it can sometimes lead to side effects such as retinal damage, vision loss, or even glaucoma over time. Our eye doctors will thoroughly discuss these potential risks with you to determine the best approach.
Surgery can be an important part of treatment, especially when the tumor is large or when preserving vision is no longer possible. Two primary surgical options include tumor removal and enucleation—the removal of the entire eye. While the idea of losing an eye may seem daunting, modern prosthetic eyes are designed to look natural and move in a way that mimics the natural eye.
Surgical removal is usually considered when other treatments are not feasible or when there is a significant risk of the cancer spreading beyond the eye. Our eye doctors will work with you to evaluate all factors, including potential side effects and the overall impact on quality of life.
For very small tumors, laser therapy—specifically transpupillary thermotherapy (TTT)—may be used as a treatment option. This technique utilizes the heat from a laser to shrink the tumor. Laser therapy is often employed either as a primary treatment for small tumors or as an adjunct treatment following other procedures such as radiation therapy to improve overall results.
While laser therapy is less invasive than surgery, its effectiveness depends heavily on the tumor’s size and location. As with any treatment, our eye doctors will carefully assess whether laser therapy is the most appropriate option for your particular condition.
Sometimes, if a tumor is very small and does not show signs of rapid growth, a careful monitoring approach may be recommended. This “watch and wait” strategy involves regular eye examinations and imaging studies to track the tumor’s progression over time. The goal is to ensure that any changes are caught early enough to adjust the treatment plan if necessary.
Many patients find comfort in the fact that not every case of choroidal melanoma demands immediate invasive treatment. However, this approach requires vigilance and a strong partnership with our eye doctors to ensure that the condition is kept under continuous observation.
Contact our office today to schedule an eye examination and take proactive steps for your vision health.
Choroidal melanoma is a serious condition that, like all cancers, must be managed with care and urgency. One major concern with this type of melanoma is that if it spreads outside the eye—a process known as metastasis—it can have significant health implications. The liver, lungs, and bones are the most common sites for metastasis from choroidal melanoma.
The prognosis often depends on several factors, including the tumor’s size, its precise location in the eye, and underlying genetic characteristics. For instance, larger tumors and those with aggressive genetic markers have a higher risk of spreading. Early detection and prompt treatment are therefore essential for achieving the best possible outcomes.
According to research and clinical experience, if choroidal melanoma is diagnosed while it is still small and asymptomatic, the chances for successful management are excellent. However, once the tumor grows larger or exhibits signs of breaking down the surrounding tissue—as seen by the presence of orange pigment and subretinal fluid—the risks increase substantially. This underscores why regular eye exams are so crucial, particularly for individuals with risk factors.
It is completely understandable to feel overwhelmed if you are presented with a diagnosis of choroidal melanoma. While the condition is rare, its impact on vision and overall health makes awareness and early intervention vital. Our eye doctors are here not only to provide cutting-edge treatments but also to support you every step of the way.
Here’s what you should remember:
From detailed eye examinations to a range of treatment options—including radiation therapy, surgery, laser therapy, and careful monitoring—our eye doctors focus on a personalized approach for each patient. Your treatment plan is determined by numerous factors including the tumor’s size, location, and genetic properties, and you will receive guidance aimed at preserving as much vision as possible while effectively managing the cancer.
Early detection can make all the difference when it comes to the treatment of choroidal melanoma. Since early-stage tumors typically do not present with noticeable symptoms, they are often discovered during routine examinations. This proactive approach has a twofold benefit: it reduces the risk of significant vision loss and increases the likelihood of successful treatment before the cancer has a chance to metastasize.
The subtle signs—like slight changes in vision, the appearance of floaters, or flashes of light—might be easily overlooked. That’s why maintaining a schedule of regular eye exams, even if you feel perfectly fine, is pivotal. If your eye exams reveal any atypical findings, our dedicated team will discuss the findings in clear, accessible language and outline the next steps together with you.
When facing a diagnosis such as choroidal melanoma, a collaborative relationship with your eye doctors is key. They are prepared to answer your questions about the nature of the tumor, the potential risks involved, and the range of treatment options available. Each recommended treatment is based on a comprehensive evaluation of your specific condition—ensuring that the plan is tailored to what you need both medically and personally.
Our eye doctors know that each case is unique. Whether the approach involves active treatment to reduce and control the tumor, or a more conservative “watch and wait” strategy, you will be guided with clear information and empathy. This collaborative effort aims to empower you to make informed decisions about your eye health with confidence.
Contact our office today to schedule an eye examination and take proactive steps for your vision health.
Choroidal melanoma is a rare eye cancer that demands early detection. Understand its risks, symptoms, and treatment options for better vision health.
