Is surgery a viable option for ocular melanoma treatment?
By: Dr. Thomas Incledon
Eye or ocular melanoma develops most often in the middle layer of the eye called the uvea. Found under the sclera (white part of the eye), the uvea houses the iris (colored part of the eye), the choroid layer of blood vessels and tissues, and a ciliary body that secretes a transparent liquid called aqueous humor into the eye. This cancer can also occur in the outer layer of the eye affecting the cornea.
When trying to understand an ocular melanoma diagnosis, patients should know that the location of the tumor matches the prognosis. In other words, the more difficult the area is to treat, the worse the long-term prognosis. This is related to how rare the cancer is. “If we have thousands of options for treatment, you’ll have better outcomes,” explains Dr. Tom Incledon, Founder & CEO of Causenta. “The FDA doesn’t recognize all the strategies we use for cancer treatment. We know people are living and living well because what we are doing works.”
In order to diagnosis and make treatment recommendations for ocular melanoma, an oncologist should perform an eye exam and then an eye ultrasound, which produces images of the eye. There are also other tools that help with imaging, such as an angiogram that shows the blood vessels around the tumor and cameras with special filters that can take pictures every few seconds to give a more complete view of the tumor.
In some cases, a doctor will perform a biopsy to determine if melanoma is present and if there are genetic components to the cancer. However, this invasive procedure is not always necessary or practical based on the location of the ocular melanoma and the availability of new technology that provides accurate results.
Surgery, radiation, and chemotherapy are traditionally recommended to treat any cancer type. For ocular melanoma, treatment will depend on the location of the cancer and the overall health of the patient.
Surgery can be considered for patients with localized disease, meaning the tumor is only in the eye and the cancer can be removed. “The challenge with surgery is that the protocol is to cut around a tumor, not through it, so healthy tissue is also removed,” says Incledon. “In a small area such as the eye, this often means removing the entire eye.” If your surgeon recommends this course of action, remember to ask about what the follow-up will be. What can you expect regarding your quality of life with one eye? Also, surgery only removes the tumor and there may be cancer cells lingering in the blood that can spread throughout the body. Ocular melanoma patients need to understand how they will be tested following surgery to help prevent metastasis and recurrence.
Radiation, laser, and cold therapies are also options for patients with localized disease. These strategies are less invasive than surgery and can kill cancer cells. Radiation uses high-powered energy; laser and infrared treatments can be paired with a substance that pops the cancer cells like bubbles. Recently, cryo therapies have been used to freeze the cancer cells away. “When combined with other strategies, there is evidence that these cold therapies can be effective,” notes Incledon.
Patients with metastasis are treated differently than those for whom surgery is a viable option. Often for these patients, chemotherapy is recommended in addition to or instead of a localized strategy like surgery.
If you are interested in learning more about ocular melanoma and treatment options with Causenta, contact us for a complimentary 30-minute consultation today.