What Is the Survival Rate for Ocular Melanoma?

If your doctor catches and treats ocular melanoma (a kind of eye cancer) before it spreads to other organs, you have an 85% chance of being alive five years after diagnosis. If it’s metastasized to distant organs (as opposed to nearby lymph nodes, for example), the five-year survival rate drops to 13%.

Eye cancer occurs when cells in the eye grow out of control. The most common type of eye cancer is intraocular melanoma, though it’s still a fairly rare type of cancer. 

Ocular melanoma usually develops in the uvea (uveal melanomas) and rarely in the conjunctiva (conjunctival melanomas).

What Are Symptoms of Ocular Melanoma?

Ocular melanoma and other eye cancers may not cause symptoms early on unless the cancer grows in certain parts of the eye or becomes more advanced. When symptoms of ocular melanoma occur, they may include:

• Vision problems (blurred vision or partial or total sudden loss of vision)
• Floaters or flashes of light
• Partial loss of the field of sight
• A growing dark spot on the colored part of the eye (iris)
• Change in size or shape of the pupil 
• Change in position of the eyeball within the socket
• Bulging eye
• Change in the way the eye moves within the socket
• Lump on the eye or in the eyelid that is growing
• Pain in or around the eye (rare)

The exact cause of most eye cancer is unknown. 

Risk factors for developing ocular melanoma include: 

• Race/ethnicity
  • The risk is higher in whites than it is in African Americans, Hispanics or Asian Americans
• Eye color
  • People with light colored eyes are slightly more likely to develop uveal melanoma than people with darker eye and skin color
• Age 
  • Risk increases as people age
• Gender
  • Slightly more common in men than in women
• Certain inherited conditions
  • Dysplastic nevus syndrome 
  • Many abnormal moles on the skin
  • Abnormal brown spots on the uvea (oculodermal melanocytosis or nevus of ota) 
  • Bap1 cancer syndrome 
  • Moles (nevi) in the eye or on the skin 
• Family history (rare)
• Unproven risk factors
  • Sun exposure: a known risk factor for melanoma of the skin, it may be a possible risk factor for uveal or conjunctival melanoma of the eye, but more research is needed 
  • Certain occupations: welders may have a higher risk of uveal eye melanoma (of the choroid and ciliary body), but more studies are being done
  • Skin melanoma: some patients with uveal eye melanoma have a history of melanoma of the skin, but it is unknown if this increases the risk of eye melanoma

Ocular melanoma is diagnosed with an eye exam, patient history, and tests such as: 

• Imaging tests
  • Ultrasound
    • Ultrasound biomicroscopy (UBM)
  • Optical coherence tomography (OCT)
  • Fluorescein angiography
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI) scan 
  • Chest X-ray (to see if the cancer has spread to the lungs)
• Biopsy
  • Fine needle aspiration
  • Incisional or excisional biopsy (cutting out part or all of the tumor)
  • Fine needle biopsy of the tumor
  • Liquid biopsy
• Blood tests
  • Liver function tests (to check if the cancer has spread to the liver)

Treatment for ocular melanoma may include one or more of the following: 

• Surgery 
  • Iridectomy: Removal of part of the iris 
  • Iridotrabeculectomy: Removal of part of the iris, plus a small piece of the outer part of the eyeball
  • Iridocyclectomy: Removal of a portion of the iris and the ciliary body
  • Transscleral resection: Surgical removal of just a melanoma of the ciliary body or choroid
  • Enucleation: Removal of the entire eyeball
  • Orbital exenteration: Removal of the eyeball and some surrounding structures such as parts of the eyelid and muscles, nerves, and other tissues inside the eye socket. May be used for melanomas that have grown outside the eyeball into nearby structures. 
• Radiation therapy 
  • Brachytherapy (plaque therapy)
  • External beam radiation therapy
    • Proton beam radiation therapy
    • Stereotactic radiosurgery
• Laser therapy 
  • Transpupillary thermotherapy (TTT) is the most common type of laser treatment for eye melanoma that uses infrared light to heat and kill the tumor
  • Laser photocoagulation uses highly focused, high-energy light beams to burn tissue (rarely used because of side effects and a high risk of recurrence)
• Chemotherapy 
  • Melanoma usually does not respond well to standard chemo drugs
  • Used only when the cancer has become widespread, and treatment is generally the same as for melanoma of the skin
• Targeted drugs and immunotherapy 
  • Pembrolizumab (Keytruda)
  • Ipilimumab (Yervoy)

Life expectancy for ocular melanoma is often expressed in 5-year survival rates, that is, how many people will be alive 5 years after diagnosis. 

Ocular melanoma 5-year survival rates:

• Localized (no sign the cancer has spread outside the eye): 85% 
• Regional (cancer has spread outside the eye to nearby structures or lymph nodes): 71% 
• Distant (cancer has spread to distant parts of the body such as the liver): 13%