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What Is Ocular Melanoma?

Ocular melanoma is a malignant tumor that arises from melanocytes within eye or ocular adnexal tissues. The most common primary intraocular form in adults is uveal melanoma, which involves the iris, ciliary body, or choroid. Melanoma can also develop on the conjunctiva or, less often, in the orbit. These tumors can grow silently for some time before causing symptoms such as blurred vision, floaters, or a visible dark spot. Metastasis, especially to the liver in uveal melanoma, is a major concern.

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What Is Ocular Melanoma?

Ocular melanoma is a malignant tumor that arises from melanocytes within eye or ocular adnexal tissues. The most common primary intraocular form in adults is uveal melanoma, which involves the iris, ciliary body, or choroid. Melanoma can also develop on the conjunctiva or, less often, in the orbit. These tumors can grow silently for some time before causing symptoms such as blurred vision, floaters, or a visible dark spot. Metastasis, especially to the liver in uveal melanoma, is a major concern.

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Types and Common Locations

Uveal melanoma accounts for most ocular melanomas and usually starts in the choroid, presenting as a pigmented or occasionally amelanotic mass under the retina. Iris melanomas arise from iris stroma and can appear as growing pigmented nodules or diffuse thickening. Conjunctival melanoma begins on the ocular surface and can spread along or beneath the conjunctiva. Each location has distinct clinical behavior, risk factors, and treatment approaches. Careful slit lamp and fundus examination helps identify these tumors early.

Symptoms and Risk Factors

Small uveal melanomas may cause few or no symptoms and are sometimes found during routine dilated examination. Larger lesions can cause blurred vision, visual field defects, flashes, floaters, or metamorphopsia. Conjunctival melanomas can appear as raised, pigmented lesions with feeder vessels. Risk factors for uveal melanoma include fair skin, light eye color, certain preexisting choroidal nevi, and possibly ultraviolet exposure. Family history and some genetic syndromes also influence risk in a minority of patients.

Diagnosis, Imaging, and Staging

Diagnosis of uveal melanoma relies on clinical features combined with ultrasonography, optical coherence tomography, and sometimes fluorescein or indocyanine green angiography. Features such as thickness, subretinal fluid, orange pigment, and documented growth support a diagnosis of melanoma over a benign nevus. Conjunctival melanoma is confirmed by biopsy and histopathology. Systemic staging with liver imaging and other tests evaluates for metastasis at baseline and during follow up. Genetic testing of tumor tissue helps estimate metastatic risk in many centers.

Treatment and Prognosis

Treatment options for uveal melanoma include plaque brachytherapy, proton beam radiotherapy, and, in selected cases, local resection or enucleation. Conjunctival melanoma is managed with wide local excision, cryotherapy, topical chemotherapy, or radiotherapy, depending on extent. Long term monitoring for local recurrence and metastasis is essential. Survival and visual outcomes depend on tumor size, location, genetic class, and response to treatment. Advances in systemic therapy are changing options for metastatic disease, though prognosis in that setting is still guarded.

FAQs About Ocular Melanoma

Is an ocular nevus the same as melanoma?

No, a nevus is a benign pigmented lesion, though some nevi can transform, so monitoring is advised.

Can ocular melanoma spread to the rest of the body?

Yes, metastasis, especially to the liver in uveal melanoma, is a major risk and reason for regular systemic checks.

Will treatment always cost me the eye?

Many uveal melanomas are treated with eye–sparing radiotherapy, though some large or complex tumors still need enucleation.

Should family members be screened?

Routine screening of relatives is not standard for most patients, but anyone with visual changes should have a dilated eye exam.

References

American Academy of Ophthalmology. ?What is Ocular Melanoma?? https://www.aao.org/eye-health/diseases/what-is-ocular-melanoma

National Cancer Institute (NCI). ?Intraocular (Eye) Melanoma Treatment (PDQ?).? https://www.cancer.gov/types/eye/hp/intraocular-melanoma-treatment-pdq

EyeWiki. ?Choroidal and Ciliary Body Melanoma.? https://eyewiki.org/Choroidal_and_Ciliary_Body_Melanoma

NCBI Bookshelf (StatPearls). ?Ocular Melanoma.? https://www.ncbi.nlm.nih.gov/books/NBK551647/

Mayo Clinic. ?Eye Melanoma.? https://www.mayoclinic.org/diseases-conditions/eye-melanoma/symptoms-causes/syc-20372371