Eye (ocular) melanoma

A cancer diagnosis of any kind causes stress, and learning that you have eye cancer may feel particularly overwhelming. It’s important to see experienced specialists who are skilled in recognizing, diagnosing and treating eye cancer.

At Penn Medicine, our specialists provide comprehensive care for people with eye (ocular) melanoma. We work closely with ophthalmologists (eye doctors) at Penn’s Scheie Eye Institute in a multidisciplinary, team approach.

Melanoma is an aggressive type of cancer that most often grows in the skin. Melanoma develops in melanocytes, which are cells that make melanin (pigment that produces color in the eyes, hair and skin).

Ocular melanoma, the most common type of eye cancer, begins in melanocytes in the eyes. Although it can develop anywhere in the eye, ocular melanoma usually develops in the eyeball’s middle layer (uvea). The uvea is below the white layer of the eye (sclera) and contains the iris (colored part of your eye).

Ocular melanoma, also known as eye melanoma, is classified based on its location within the eye. Here are the main types:

• Choroidal melanoma: Occurs in the choroid, the layer of blood vessels near the back of the eye.
• Ciliary body melanoma: Develops in the ciliary body, the muscle fibers around the lens of your eye.
• Iris melanoma: Forms in the iris, the colored part of the eye.
• Conjunctival melanoma: Occurs in the conjunctiva, the thin, clear tissue covering the white part of the eye and the inside of the eyelids.
• Orbital melanoma: Develops in the orbit, the bony cavity in the skull where the eye and its associated structures are located.
• Eyelid melanoma: Occurs on the skin of the eyelid.

Ocular melanoma may not show any signs or symptoms at first. When symptoms do develop, they may seem similar to those of other, less serious conditions. That’s why it’s important to see your doctor or an ophthalmologist (eye doctor) if you experience symptoms such as:

• Change in the shape or size of the pupil (dark circle in the middle of the iris)
• Changes in the eyeball’s position or movements within the socket
• Eyes that bulge
• Growing, dark spot on the iris
• Sensation of flashing lights or “floaters” (small spots) in your field of vision
• Vision problems, such as blurry vision or losing part of your field of vision

Certain factors increase your risk for developing ocular melanoma. These include:

• Exposure to sunlight or artificial sunlight from tanning beds.
• Having light-colored eyes
• Older age
• Being Caucasian
• Inherited skin conditions, such as dysplastic nevus syndrome, which cause abnormal moles
• Having a mole on the surface of the eye
• Abnormal skin pigmentation involving the eyes or eyelids

The causes of ocular melanoma are unknown, but certain factors can increase your risk of developing it.

Your eye doctor may find ocular melanoma during your routine eye exam, especially if you have symptoms. Our specialists do a thorough evaluation that includes diagnostic testing to confirm a diagnosis.

Ocular melanoma-specific testing may include:

• Eye ultrasound: An eye ultrasound uses high-frequency sound waves from an instrument called a transducer and produces images of the eye for a more accurate diagnosis. We place numbing drops in the eye to make the procedure more comfortable.
• Biopsy: Your ophthalmologist may remove a small sample of tissue from the surface of the eye, which is then sent to a laboratory to be examines and tested for melanoma.
• Fluorescein angiography: This is a diagnostic procedure where dye is injected into the arm that travels to the eye. A specialized camera takes pictures of the inside of the eye to determine if they are any abnormalities, leakage or blockage.

Find out more about our process for melanoma diagnosis and second opinions on a cancer diagnosis.

With an accurate diagnosis, our team works closely with you to create a customized treatment plan. Treatments focus on destroying the cancer, saving the eye and preserving your vision as much as possible. Learn more about your melanoma treatment options, including:

• Immunotherapy
• Surgery
• Targeted therapy
• Eye cancer care with Penn Ophthalmology at the Scheie Eye Institute

Ocular melanomas are rare, complex cancers in delicate eye structures, and they may affect your vision and appearance. At the Tara Miller Melanoma Center, part of the Abramson Cancer Center, our specialist team provides compassionate care. We offer:

• Team expertise in melanoma treatments: Our cancer specialists have years of experience in the newest treatments for ocular melanoma. Targeted therapy, immunotherapy, radiation therapy and laser treatments destroy melanoma while preserving eye structure and vision, when possible.
• Skilled eye surgeons: Our cancer surgeons and ophthalmologists have specialized training in intricate surgical procedures to remove ocular melanoma. When possible, we remove only the part of the eye with melanoma to help preserve eye function and appearance.
• Comprehensive services for reconstruction: We coordinate your care with our colleagues in plastic and reconstructive surgery, if you have had eye surgery for ocular melanoma. Oculoplastic surgeons are specialized ophthalmologists who perform delicate surgeries around the eye. These techniques can improve eye function and appearance after cancer surgery. Learn more about our Oculofacial and Orbital Surgery Service.