Our topic this month will be choroidal melanoma.
What is a choroidal melanoma?
Melanoma is a type of cancer that can affect several parts of the eye. The choroid is the most commonly affected area. It develops in the cells that make melanin, the pigment that is also found in the skin. A choroidal melanoma may arise from a choroidal nevus or on its own without an existing condition. It usually affects older patients and risk increases with age.
What are the symptoms?
Often, patients do not notice any symptoms from this type of cancer. Some patients may experience floaters, flashing lights, blurry vision, or loss of peripheral vision. It is important to note that these symptoms are not specific to a cancerous process, so an exam is necessary for a definitive diagnosis.
How is this detected?
A comprehensive exam is necessary to diagnose choroidal melanoma. The doctor may order a fluorescein or indocyanine green (ICG) angiography. The photos from this test help to further characterize and definitively diagnose a melanoma. Doctors look for specific characteristics that are indicative of a cancerous process including the thickness of the lesion, presence of fluid, and orange pigmentation. An ultrasound of the eye can be done to assess how thick the melanoma is. A large melanoma may also cause a retinal detachment.
The arrow in this photo points to a choroidal melanoma.
What are the treatments?
There are several treatments available depending on the size of the melanoma. It is common to observe small melanomas and treat if it grows or a patient has complications. Other treatments include partial removal of the tumor, removal of the eye (enucleation), radiation therapy, and thermotherapy which involves heating the tumor. A combination of these therapies may be required. Ultimately, a specialist will determine the best treatment plan.
This cancer can spread to other areas of the body, which is a process called metastasis. The most common site is the liver. It is important to have regular follow up and testing to ensure that the cancer has not spread.
Return next month for a discussion on a new topic!