Ocular (eye) melanoma

Melanoma is a type of cancer that most often begins in the skin. It develops in cells called melanocytes. These cells make melanin, the pigment that gives your hair, skin, and eyes their color.

Ocular melanoma starts in the eye, not the skin. Although it is rare overall, it is the most common type of cancer that originates in the eye. This disease occurs when melanocytes within the eye grow uncontrollably. Most ocular melanomas develop in the uvea, the middle layer of the eye located beneath the white outer layer, called the sclera, which includes the iris, or colored part of the eye.

Being diagnosed with any cancer can be stressful. Learning you have eye cancer may feel especially overwhelming. Getting care from experienced specialists can make an important difference. At Penn Medicine, our team works closely with eye specialists at the Scheie Eye Institute, so your care is well coordinated from diagnosis through treatment.

Ocular melanoma may not cause symptoms at first. When symptoms do appear, they can be similar to common eye problems. Contact your doctor or an ophthalmologist (eye doctor) if you notice:

• A dark spot on the iris that gets bigger over time
• Flashes of light or small spots in your vision
• Blurry vision or a sudden change in vision
• Loss of part of your field of vision
• A change in the size or shape of the pupil, the dark center of your eye
• Less commonly, bulging of the eye or a change in its position

The exact cause of ocular melanoma isn’t known. However, certain factors may increase your risk, including:

• Light-colored eyes, such as blue or green
• Fair or light skin
• Older age
• Some inherited conditions that affect the skin or cause abnormal moles
• A mole in or on the eye, called an ocular nevus
• Unusual pigmentation of the eye or nearby skin

Sun exposure may play a role, but its link to ocular melanoma is not as clear as it is for skin melanoma.

Your eye doctor may detect ocular melanoma during a routine eye exam, sometimes even before symptoms appear. If melanoma is suspected, our specialists perform a detailed evaluation to confirm the diagnosis and learn more about the tumor. Tests may include:

• Eye ultrasound: Sound waves create images of the inside of the eye.
• Biopsy: In some cases, a small tissue sample is taken and examined in a lab.
• Fluorescein angiography: A dye is injected into a vein in your arm, and a camera takes images of blood flow in the eye.

You may also have a dilated eye exam or other imaging tests to help guide your care.

Yes, doctors stage ocular melanoma based on the size of the tumor and whether it has spread outside the eye. Staging helps guide treatment and follow up care. Your care team will explain what your stage means and what to expect.

After treatment, ongoing follow up care is an important part of managing ocular melanoma. Regular checkups help your care team monitor your eye health and look for signs that the cancer could return or spread. Follow up care may include:

• Routine eye exams
• Imaging tests or scans
• Blood tests or other exams, based on your individual risk

Your team will create a follow up plan based on your diagnosis and treatment and will explain how often you need to be seen.

Ocular melanomas are rare, complex cancers that develop in delicate structures of the eye and may affect vision and appearance. At the Tara Miller Melanoma Center, part of the Abramson Cancer Center, our team provides expert, compassionate care in a supportive setting. We offer:

• Melanoma specialists: Doctors with experience treating ocular melanoma use proven, evidence‑based approaches.
• Eye cancer surgery: Skilled surgeons treat eye tumors with care to help preserve eyesight.
• Reconstructive care: We partner with plastic and oculoplastic specialists to support healing and appearance after treatment.