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Frequently Asked Questions

What is Uveal Melanoma?
Uveal melanoma is a rare tumor in the eye. 

Is this cancer?
Yes, this tumor is a malignant cancer and can spread to other areas of the body.  The most common site for it to spread is the liver.

Are there any symptoms of uveal melanoma?
Often there are no symptoms. If the tumor is large, it can cause the retina to detach. This can cause flashing lights in the eye, floating particles, blurred vision or even loss of vision. These are serious symptoms and should be evaluated by an ophthalmologist as soon as they are noticed.
 
What causes uveal melanoma?

The cause is not known. Sun exposure is not known to cause this eye cancer. It does not come from a melanoma in another part of the body.

Is it a common cancer?
No, it is very rare, but is the most common eye tumor in adults. Only about six people in one million will be diagnosed with it each year.

Are certain types of people more at risk to getting this type of cancer?
Yes, fair skinned people with light colored eyes are more at risk for this type of eye cancer. It is also seen more often in persons over 50 years of age.

Can I do anything to prevent this cancer?
There is nothing that you have done that caused it, and there is nothing that you can do to prevent this cancer.

Is it hereditary?
No, it is not hereditary. There have only been a few cases where members of the same family have had a melanoma in the eye.

What areas of the eye are involved?
The uveal area is the middle layer of the eye. It includes the colored part of the eye (iris), the muscle behind the iris (ciliary body) and the layer in the back of the eye (choroid), which has blood vessels that nourish the light sensitive part of the eye (retina). Most uveal melanomas are on this back layer (choroid layer), and are called choroidal melanomas.

How is it diagnosed?
Very often, a freckle, nevus or spot is noticed on the back of the eye (retina) during a routine eye exam. These spots are not always malignant tumors, but sometimes they can develop into a malignant tumor. It is important that a retinal specialist completes a dilated exam of the area to confirm a diagnosis.

Are there any tests to help with the diagnosis?
Yes, an ultrasound exam of the eye can determine the size and thickness of the tumor. It can also show the internal characteristics of the tumor. Photographs of the back of the eye (retina) will show the tumor. Also, a fluorescein angiogram will show the blood vessels around the tumor. All these tests help the doctor to decide if it is a melanoma.

What is a fluorescein angiogram?
A fluorescein angiogram is a photographic test performed with a dye. A small amount of yellow dye is injected into the vein in your arm. The photographer takes timed pictures of the back of your eye, as the dye circulates through the blood vessels in your eye.

How is an ultrasound of the eye performed?
An ultrasound is most often done through closed lids. A layer of gel will be applied to the surface of your closed lids. Then the transducer probe, which is about the size of a large pen, is gently moved over your closed lids. You will be asked to look indifferent directions during the exam. 

What happens during my consultation visit at Mass. Eye and Ear?
At the consultation visit, each patient meets with a nurse who completes an initial eye exam and reviews your eye and health history, including medications. Next, each patient has an ultrasound of the eye. The retina fellow who is working with your doctor sees you next, and then your doctor will see you, and make a diagnosis. Photographs and a fluorescein angiogram are usually performed to help with the diagnosis. At times, additional photographs and ultrasounds are needed to provide additional information.

Who is the other doctor working with my doctor?
Mass. Eye and Ear is a teaching hospital of Harvard Medical School. This means doctors who are gaining additional expertise in a subspecialty of ophthalmology, (such as retina), will work with the doctors who are faculty of Harvard Medical School. Your doctor is a Professor at Harvard Medical School, and very experienced in the diagnosis and treatment of uveal melanoma.

What is the difference in size of a small, medium or large tumor?
Tumors less than 2 mm in height are considered small. Tumors between 2 and 5 mm are considered medium in size.  Large tumors are usually more than 5 mm in height. There are other factors that determine the size of the tumor and the best type of treatment. It is best to discuss this with your doctor.

Will I have a biopsy?
Some ophthalmologists take a biopsy of the tumor. However, these tumors are very small, and it is sometimes difficult to be sure the doctor actually has a piece of the tumor to examine. Here at Mass. Eye and Ear, the doctors do not biopsy melanomas.

What treatments are available?
For lesions that cannot be definitively diagnosed as melanoma, the doctor may watch the spot (observation) and have you return for regular visits to measure its size and shape. For more than 25 years, the doctors at Mass. Eye and Ear have been using Proton Beam Irradiation to treat melanomas. In the past, removal of the eye (enucleation) was the only treatment option. 

What is Proton Beam Irradiation?
There are several types of radiation used to treat medical conditions. Proton Beam Irradiation is an external beam treatment. It is extremely precise and can be aimed directly at the tumor. It is more easily controlled and is more suited to a tumor or condition that can be measured exactly in size and shape.

How does it differ from the usual radiation people with cancer receive?
Proton Beam Irradiation travels in a straight line and can be controlled to stop where it is needed. The beam increases in strength as it comes to a stop at the tumor area. The proton beam usually spreads less (less scatter) into the surrounding tissue of the eye, and causes less damage where it enters the eye. 

What effects can you expect from it?
As with all radiation treatments, Proton Beam Irradiation will damage the tumor cells and prevent them from continuing to grow. 

What are the most common side effects from this treatment?
The most common long term side effects are dry eye and excessive watering of the eye. This may occur due to changes in the eye lashes or tear ducts. Proton Beam Irradiation sometimes causes a mild burn on the eye lid, which can be treated with ointment. Occasionally, the white part of the eye has some redness that looks like irritation, from blood vessels that have increased in size. Hair loss or nausea are not associated with this treatment.

Are there more serious side effects?
With very large tumors, abnormal blood vessels can grow inside the eye. This can cause an increase in eye pressure and pain, which can usually be treated with medication. About 10 percent of patients who have this treatment will have these effects. Most patients also lose vision as a result of the radiation, but the degree of vision loss depends on the size of the tumor and its location in the eye. Some people develop cataracts in the treated eye. This can be taken care of as any cataract would.

How long is treatment?
Treatment is usually completed in five consecutive days.  Each treatment lasts only a few minutes, and is painless. It does require some time to set up the machine and get the patient in the correct position. Appointments are usually scheduled for 30 minutes each.

Is there any surgery involved in treatment?
Here at Mass. Eye and Ear, the doctor will start treatment by placing 4 to 5 tantalum rings around the edge of the tumor. Each of these rings is about the size of a small circle you might draw with a pen, for example: Θ (2.5 mm wide). The doctor does this by leaving the eye in place and going behind the eye. The rings mark the tumor edges and allow the proton beam to be aimed precisely. The operation lasts about one hour and general anesthesia is used so the patient is asleep. Usually, you will be discharged from the hospital on the same day.

Is the surgery painful?
As with any operation, patients can expect a moderate amount of discomfort the first evening. Patients are given a prescription for pain medication in case it is needed to stay comfortable.

Will my appearance change in any way?
After surgery the white part of the eye becomes very red, and the eye lid can become black and blue in color. This will heal itself after a couple of weeks.

Will I need any medication after surgery?
Yes. An eye drop is prescribed that will dilate the eye. This dilation promotes healing. An antibiotic ointment is also prescribed to prevent infection.

How successful is the treatment?
The tumor shrinks and does not return in 95 percent of the cases. Nearly everyone (90 percent) treated this way is able to keep their eye.

What are the chances of spreading to another part of the body?
About 25 percent of the patients treated with Proton Beam Irradiation end up with the melanoma spreading to another part of the body after 15 years.

Is it safer to have the eye removed (enucleation)?
Studies show that there is no difference in outcome whether you have Proton Beam Irradiation or have the eye removed. 

Will I lose my vision?
This depends on where the tumor is in relation to the optic nerve and the macula (center of the retina) and how large it is. Your doctor can give you more information about this.

What tests should I have to be sure the cancer is not spreading?  How often should they be done?
A blood sample is taken annually to monitor changes in the liver function. If any of these tests appear abnormal, the doctor will request a CT scan of the liver. 

How often will I return to Mass. Eye and Ear for follow-up after my treatment?
You will be followed every six months for the first five years, and then every year after that. At each visit, the doctor will request testing to measure the size of your tumor. The tests will show that the tumor is shrinking.

Should I see another oncologist?
That decision is up to you. You can discuss this with the doctor here or with your primary care provider.