Ocular Melanoma – Cancer in the Eye

by admin-blog-kh | November 6, 2025 6:24 am

What is ocular melanoma? 

Ocular melanoma is a type of cancer that develops in melanocytes, the cells that produce melanin, the pigment responsible for the colour of the eyes and skin. This cancer occurs in the middle layer of the eye (uvea) or the conjunctiva (a thin, transparent membrane covering the front of the eye and the inside of the eyelids). Since these melanomas develop in areas of the eye that are not visible in the mirror, they can be difficult to detect and often do not cause noticeable signs or symptoms.

Ocular melanomas account for approximately 3%–5% of all melanomas. About 85% of ocular melanomas occur in the uvea, with 5% affecting the iris and the remainder arising from the choroid and ciliary body. Approximately 10% of ocular melanomas occur in the conjunctiva. The median age of diagnosis is 62 years, with the highest number of cases occurring between 70–79 years.

Types of ocular melanoma 

Uveal melanoma

This is the most common type of ocular melanoma and occurs in the uvea, which has three main parts:

• Iris: The coloured part of the eye surrounding the pupil that regulates light entry. Iris melanoma is usually small, slow-growing, and does not typically spread.
• Ciliary body: Located behind the iris, it controls the lens shape to help focus vision. Tumours here tend to be larger and more likely to spread.
• Choroid: A vascular layer supplying nutrients and oxygen to the eye. Most ocular melanomas start in the choroid, often growing larger and spreading to other parts of the body.

Conjunctival melanoma

A rare type of ocular melanoma that appears as a pigmented spot on the eye’s outer surface. It can sometimes be mistaken for a benign freckle or mole, making early diagnosis crucial.

Risk factors

• More common in Caucasians and older adults, with men having a 30% higher risk than women.
• Fair-skinned individuals with light-coloured eyes (blue/green) and skin that burns or freckles easily.
• Prolonged exposure to natural or artificial sunlight (e.g., tanning beds) increases the risk of conjunctival melanoma.
• Presence of a mole on the eye’s surface or within the eye.
• Increased uveal pigmentation or abnormal skin pigmentation, including on the eyelids.
• Genetic mutations in BAP1, EIF1AX, and SF3B1 genes.
• Conditions like dysplastic nevus syndrome (characterized by multiple abnormal moles) and occupational exposure (e.g., arc welding).

Symptoms of ocular melanoma 

According to ophthalmologists[14], ocular melanomas are often asymptomatic in the early stages and may only be detected during a routine eye exam. When symptoms do occur, they may include:

• Distorted or blurred vision
• Dark spots on the iris or a blind spot in peripheral vision
• Changes in pupil size and shape
• Altered eyeball position
• Eye floaters or flashes of light
• Eye pain due to increased intraocular pressure or pressure on the ciliary nerves

Diagnosis 

Patient history

Many patients are asymptomatic, and ocular melanoma is often discovered during a routine eye exam. Symptoms vary depending on tumour location:

• Choroidal tumours may remain asymptomatic for long periods.
• Ciliary body tumours may go unnoticed until they affect neighbouring structures.
• Iris tumours may show rapid growth in a nevus present since childhood.

Physical examination

• Choroidal melanomas: Initially dome-shaped and well-defined, they may later form a mushroom shape as they grow. The tumour colour ranges from light to dark, with retinal pigment atrophy and yellow deposits (drusen).
• Iris melanomas: Can be diffuse or well-circumscribed, with colours ranging from yellow to brown.
• Ciliary body melanomas: Presence of an early sentinel vessel (abnormal blood vessel) may prompt further examination.

Imaging and Diagnostic Tests 

• Ultrasound: Uses sound waves to create an image of the eye, detecting tumours as small as 2 mm.
• Fundus imaging: Helps assess tumour size, location, pigmentation, and retinal detachment.
• Optical coherence tomography (OCT)[15]: Provides cross-sectional images of the retina and optic nerve to measure changes over time.
• Fundus fluorescein angiography: Uses injected dye to highlight blood flow abnormalities.
• MRI: Determines tumour size, location, and surrounding tissue involvement.
• Biopsy: Rarely performed but may be used for genetic profiling and prognostic assessment.
• Laboratory tests: Since ocular melanoma spreads via the bloodstream, liver function tests and imaging (e.g., liver MRI, chest CT) are recommended if metastasis is suspected.

Treatment options 

The choice of treatment depends on tumour size and location:

• Observation: Small, asymptomatic tumours (<12 mm diameter, <3 mm height) are monitored every 2-4 months.
• Plaque brachytherapy: Radioactive seeds are placed near the tumour for 4-5 days to kill cancer cells.
• Transpupillary thermotherapy: Uses infrared heat as an adjunct to radiation therapy.
• Surgical removal:
  • Tumour excision with surrounding healthy tissue.
  • Enucleation (eye removal): Recommended for large tumours, optic nerve involvement, or severe pain. A prosthetic eye is fitted after healing.
• Conjunctival melanoma treatment: Includes eye drops, chemotherapy, radiation, surgery, or cryotherapy (freezing the tumour margins).
• Immunotherapy: Tebentafusp-tebn (Kimmtrak) enhances the immune response against melanoma cells. It is suitable for patients with the HLA-A*02:01 genetic marker.

Complications 

• Vision loss
• Retinal detachment
• Cataracts
• Glaucoma
• Macular edema
• Radiation-related complications: Radiation retinopathy, neovascular glaucoma, optic neuropathy, and dry eye syndrome.
• Retinal vascular occlusion following thermotherapy.

Prognosis 

• Iris melanoma: 0%-10% mortality.
• Ciliary body and choroidal melanomas: 30%-50% mortality.
• Poor prognosis factors include:
  • Advanced age
  • Large tumour size
  • Lymph node involvement and metastasis
  • Chromosomal abnormalities (missing chromosome 3, extra chromosome 8, partial loss of chromosome 6)
  • BAP1 mutation

Prevention 

• Reduce UV exposure by wearing wraparound sunglasses with UVA/UVB protection and a wide-brimmed hat.
• Schedule regular eye exams, especially if at risk or with a family history of ocular melanoma.
• Monitor any moles in or around the eye for changes.
• Maintain a healthy lifestyle with a balanced diet and exercise[17].

Living with ocular melanoma 

Adjusting to partial or complete vision loss can be challenging. Enucleation patients may struggle with depth perception and spatial awareness. Emotional and physical adaptation takes time, and support from therapists, social workers, and loved ones can be invaluable.

Conclusion 

Ocular melanoma arises from abnormal melanocyte growth, primarily in the choroid or ciliary body. Due to its asymptomatic nature, routine eye exams are crucial for early detection. Prognosis depends on tumour characteristics and genetic factors. Preventive measures, including sun protection and regular monitoring, can help reduce risks. With early diagnosis and proper treatment, patients can manage the disease effectively.

If you or a loved one are experiencing symptoms of ocular melanoma or need specialized eye care[18], expert consultation and advanced treatment are available at Kauvery Hospital. With branches in Chennai, Hosur, Salem, Tirunelveli, and Trichy, our experienced ophthalmologists and cancer care teams are dedicated to providing comprehensive[19], compassionate care for your eye health.

Frequently Asked Questions

What is ocular melanoma?

Ocular melanoma is a rare type of eye cancer that begins in melanocytes, the pigment-producing cells of the eye. It often develops in the uvea or conjunctiva and may not cause early symptoms, which is why routine eye exams are essential for detection.

What are the common symptoms of ocular melanoma?

Many people don’t notice symptoms at first, but signs may include blurred or distorted vision, dark spots on the iris, flashes of light, or changes in pupil shape. If you experience these, consult an eye specialist immediately.

How is ocular melanoma diagnosed?

Ocular melanoma is diagnosed using eye imaging tests like ultrasound, fundus photography, and OCT scans. Sometimes, MRI or genetic testing helps assess tumour type and spread. Regular eye checkups can help detect it early.

What treatment options are available for ocular melanoma?

Treatment depends on tumour size and location. Options include radiation (plaque brachytherapy), surgery, laser therapy, or immunotherapy. In advanced cases, targeted therapies can help control cancer growth and preserve vision.

Can ocular melanoma be prevented?

While it can’t always be prevented, wearing UV-protective sunglasses, avoiding tanning beds, and getting regular eye exams can reduce your risk. Early detection greatly improves treatment success.

What is the outlook for someone diagnosed with ocular melanoma?

With timely diagnosis and treatment, many patients live healthy lives. The outcome depends on tumour size, location, and genetics. Regular follow-ups and a strong support system play a key role in recovery.

 

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet, Radial Road & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and paediatric trauma care.

Chennai Alwarpet – 044 4000 6000 • Chennai Radial Road – 044 6111 6111 • Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4077777 • Trichy – Tennur – 0431 4022555 • Maa Kauvery Trichy – 0431 4077777 • Kauvery Cancer Institute, Trichy – 0431 4077777 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 68011

Source URL: https://www.kauveryhospital.com/blog/cancer/ocular-melanoma-cancer-in-the-eye/

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