Ocular (Uveal) Melanoma
Treatment for ocular (uveal) melanoma
You will be cared for by a multi-disciplinary team (MDT) of health professionals during your treatment for ocular melanoma. The team may include an ophthalmologist, radiation oncologist (to prescribe and coordinate a course of radiation therapy), medical oncologist (to prescribe and coordinate a course of systemic therapy which includes immunotherapy), nurses and allied health professionals such as a psychologist or counsellor, a social worker, physiotherapist
and occupational therapist.
Discussion with your doctor will help you decide on the best treatment for your cancer depending on:
- the site of the cancer you have (choroid, ciliary body or iris)
- size of the cancer
- how close the cancer is to other parts of the eye
- whether or not the cancer has spread
- your age, fitness and general health
- your preferences.
The main factors in deciding on what treatment you will have are the location and size of the tumour and wanting to save the sight of your eye. Preserving how your eye looks is also important. Treatments may include surgery, radiation therapy, laser treatment (transpupillary thermotherapy), photodynamic therapy and immunotherapy. These can be given alone or in combination.
Surgery for ocular melanoma may involve removing just the tumour, removing part of the eye, or removing the entire eye (enucleation) if it has been severely damaged by the tumour. These operations are done while you are under a general anaesthetic and you will have to stay in hospital for one or two days.
Surgical procedures for ocular melanoma
Iridectomy – Removal of part of the iris (coloured part of the eye)
Iridocyclectomy – Removal of part of the iris and the ciliary body
Endoresection or transscleral resection – Removal of only the tumour in the ciliary body or choroid
Enucleation – Removal of the entire eye. This is performed for larger melanomas or if the vision in the eye has already been lost. An artificial eye matching your eye size and colour will usually be inserted after surgery to replace the eye
Orbital exenteration – Removal of the eye and some surrounding tissue
Radiation therapy (also known as radiotherapy) uses high energy rays to destroy cancer cells. It may be used for ocular melanoma:
- after surgery, to destroy any remaining cancer cells and stop the cancer coming back
- if the cancer can’t be removed with surgery
- instead of removing the eye (enucleation)
- if the cancer has spread to other parts of the body (e.g. palliative radiation to control symptoms).
For ocular melanoma it is given the following ways:
Plaque radiation therapy (plaque brachytherapy) – small seeds of radioactive material are placed in a small disc (called a plaque) and attached to the wall of the eye over the tumour during an operation. Radiation is then delivered to the tumour. The plaque is left in place until the right amount of radiation has been given. This is usually about four to five days and you will have to stay in hospital during this time. After this, you will have another short operation to remove the plaque.
Proton beam radiation therapy – proton beams are aimed directly at the tumour and may cause less damage to the other tissues they pass through. Treatment is given in high doses over several days. This treatment is currently not available in Australia but check with your radiation oncologist.
Stereotactic radiation therapy – multiple small beams of radiation are used to precisely target the tumour in high doses. You usually need five sessions given over ten days.
A course of stereotactic radiation therapy needs to be carefully planned. During your first appointment you will meet with a radiation oncologist. At this planning session you will lie on an examination table and have a CT scan in the same position you will be placed in for treatment. Specific equipment, such as a frame to immobilise your head and a light to focus your gaze on, will be used to ensure your eye does not move during treatment. The information from this session will be used by your specialist to work out the treatment area, the type of radiation and how to deliver the right dose. Radiation therapists will then deliver the course of radiation therapy as set out in the treatment plan.
Radiation therapy does not hurt and is usually given over a period of time to minimise side effects.
If you need plaque brachytherapy the ophthalmologist will plan this treatment with you.
Other types of treatment for ocular melanoma are:
Laser treatment (transpupillary thermotherapy) or photodynamic therapy
This treatment uses an infrared laser to heat and destroy cancer cells. It is sometimes combined with photodynamic therapy which uses a laser combined with a light-sensitive drug to destroy cancer cells. The drug is injected into your vein and makes the cells in your body more sensitive to light. The treatment is painless, but you will be sensitive to light for several days after treatment.
If the ocular melanoma has spread (metastasised) to other parts of the body, immunotherapy may be considered. This treatment has been very helpful in treating metastatic skin melanoma and uses drugs to stimulate your own immune system to recognise and attack cancer cells.
Your doctor may suggest you take part in a clinical trial. Doctors run clinical trials to test new or modified treatments and ways of diagnosing disease to see if they are better than current methods. For example, if you join a randomised trial for a new treatment, you will be chosen at random to receive either the best existing treatment or the modified new treatment. Over the years, trials have improved treatments and led to better outcomes for people with cancer. Talk to your specialist, clinical trials nurse or GP, or ask for a second opinion. If you decide to take part in a clinical trial, you can withdraw at any time.
For more information on clinical trials visit Australian Cancer Trials.
Complementary therapies are designed to be used alongside conventional medical treatments (such as surgery and radiation therapy) and can increase your sense of control, decrease stress and anxiety, and improve your mood.
Some Australian cancer centres have developed “integrative oncology” services where evidence-based complementary therapies are combined with conventional treatments to improve both wellbeing and clinical outcomes. Let your doctor know about any therapies you are using or thinking about trying, as some may not be safe or evidence-based.
Some complementary therapies and their clinically proven benefits are listed below:
acupuncture – reduces chemotherapy-induced nausea and vomiting; improves quality of life
aromatherapy – improves sleep and quality of life
art therapy, music therapy – reduce anxiety and stress; manage fatigue; aid expression of feelings
counselling, support groups – help reduce distress, anxiety and depression; improve quality of life
hypnotherapy – reduces pain, anxiety, nausea and vomiting
massage – improves quality of life; reduces anxiety, depression, pain and nausea
meditation, relaxation, mindfulness – reduce stress and anxiety; improve coping and quality of life
qi gong – reduces anxiety and fatigue; improves quality of life
spiritual practices – help reduce stress; instil peace; improve ability to manage challenges
tai chi – reduces anxiety and stress; improves strength, flexibility and quality of life
yoga – reduces anxiety and stress; improves general wellbeing and quality of life.
Let your doctor know about any therapies you are using or thinking about trying, as some may not be safe or evidence-based.
If you have been diagnosed with ocular melanoma, both the cancer and treatment will place extra demands on your body. Research suggests that eating well and exercising can benefit people during and after cancer treatment.
Eating well and being physically active can help you cope with some of the common side effects of cancer treatment, speed up recovery and improve
quality of life by giving you more energy, keeping your muscles strong, helping you maintain a healthy weight and boosting your mood.
You can discuss individual nutrition and exercise plans with health professionals such as dietitians, exercise physiologists and physiotherapists.
All treatments can have side effects. The type of side effects that you may have will depend on the type of treatment you have. Some people have
very few side effects and others have more. Your specialist team will discuss all possible side effects, both short and long-term (including those that have a late effect and may not start immediately), with you before your treatment begins.
Common side effects may include:
Surgery – Loss of vision, damage to nearby tissue, pain, bleeding, blood clots, infection after surgery, change in appearance.
Radiation therapy – Blurry vision, dry eye, cataracts, glaucoma, loss of vision, eye discomfort, fatigue.
Laser therapy – Loss of vision, eye discomfort, bleeding inside the eye.
Immunotherapy – Infection, fatigue, skin reactions, headaches, inflammation of the heart, inflammation of the colon, inflammation of the liver, kidney problems.
This information is reviewed by
This information was last reviewed February 2021 by the following expert content reviewers: A/Prof William Glasson, Ophthalmologist, Queensland Ocular Oncology Service, Queensland; Dr Lindsay McGrath, Ophthalmic Surgeon, Queensland Ocular Oncology Service, Queensland; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Jane Palmer, Senior Oncology Nurse and Researcher, Oncogenomics Laboratory, QIMR Berghofer Medical Research Institute, Queensland Ocular Oncology Service, Queensland; Katrina Potter, Consumer; Susan Vine, OcuMel Australia; Ann Marie Weber, Consumer; Dr Wenchang Wong, Senior Radiation Oncologist, Prince of Wales Hospital, Sydney, Conjoint Senior Lecturer, University of NSW.