Ocular melanoma – Symptoms, diagnostic procedures, and therapies

The malignant melanoma, although rarely developing in the eye area, is an extremely aggressive and rapidly spreading tumor. This type of cancer is particularly dangerous in the eye, as it is often detectable only in late stages. In some cases, the tumor can be seen with the naked eye, but in most cases, it is discovered only during a fundus examination. Early diagnosis plays a key role in the success of treatment, allowing the disease to be effectively managed even in its initial stages.

Types of Eye Tumors

Eye tumors can be classified into two main categories: primary and secondary tumors. Primary tumors develop from the eye’s own tissues, while secondary tumors arise from metastases originating in other parts of the body. Among primary eye tumors, malignant melanoma is the most common in adults, particularly in those over fifty years of age. Melanoma originates from the middle layer of the eye, the uvea, most commonly from the choroid, but it can also occur in the ciliary body and the iris. In most cases, it appears in only one eye.

In the case of secondary tumors, the lesions appearing in the eye originate from other parts of the body, most commonly spreading from the lungs, skin, and kidneys. If there is a known history of cancer, it is advisable to undergo an ophthalmological examination to detect possible metastases in a timely manner.

Symptoms of Eye Melanoma

Melanoma originating from the iris can be detected with the naked eye, as it is characterized by a dark brown, raised, and unevenly surfaced lesion. Occasionally, the shape of the pupil may also change, taking on an irregular form. However, tumors originating from the choroid and ciliary body are generally not visible to laypersons. For specialists, basic ophthalmological examinations help in the early detection of lesions, even in unfavorable locations.

The presence of the tumor can also significantly affect vision. The tumor may cause distortions, such as bending or wavering of lines. Patients may perceive objects as smaller (micropsia) or larger (macropsia) than they actually are, and there may be visual field loss. Additionally, floaters and a sensation of “smoke” may occur due to cell scattering, which can lead to decreased visual acuity.

It is important to emphasize that complaints associated with vision disturbances do not always indicate melanoma. Numerous other ophthalmic conditions can cause similar symptoms, such as inflammations, hemorrhages, or benign tumors. If the patient has a history of cancer or if there is a family history of similar illnesses, special attention should be paid to ophthalmological examinations.

Ophthalmological Examinations and Diagnostic Procedures

To ensure the early detection of eye melanoma, individuals in the risk group should regularly participate in ophthalmological examinations, even in the absence of symptoms. Risk factors include being over 50 years of age, a family history of cancer, increased UV exposure, and having light-colored eyes and skin.

During ophthalmological examinations, specialists typically measure visual acuity, visual field, and intraocular pressure, and also perform pupil dilation. If changes indicative of a tumor are detected, further detailed examinations are necessary.

Ultrasound examination is an effective tool for determining the location, size, and extent of the tumor. Additionally, Color-Doppler ultrasound allows for the examination of blood flow within the vessels, providing important information about the tumor’s status.

Angiographic examinations can yield data about the tumor’s circulation and abnormal vascular networks, while imaging procedures such as MRI or CT can assist in mapping the tumor’s spread to the eye socket.

Treatment Options for Eye Melanoma

The method of treating melanoma largely depends on the size and location of the tumor. In cases of early detection, when the tumor is still small and has not spread, various treatment options are available, such as radiation therapy, laser treatment, or surgical removal. At this stage, the prognosis is favorable, and the chance of recovery is high.

In later stages, when the tumor has already spread, treatment can be much more challenging and may even necessitate the removal of the entire eyeball. In such cases, the five-year survival rate drops below 50%.

Melanoma is prone to forming metastases, most commonly in the liver, lungs, skin, and other internal organs. Therefore, it is essential to search for possible metastases during the treatment of the disease, which may require various diagnostic tests, such as chest X-rays or abdominal ultrasounds.

Patients should be continuously monitored, as the risk of recurrence remains for years. Frequent check-ups are recommended in the first year, after which the frequency of examinations can be reduced. The early detection and treatment of eye melanoma are crucial for the patient’s quality of life and survival.