Eye cancer is rare. There are a number of different cancers that can affect the eye. Eye (ocular) melanoma is the most common.
Melanoma is a cancer that develops from cells called melanocytes. Melanocytes give our skin its colour. Melanoma usually develops in the skin. But because there are melanocytes in different parts of the body, it can start in other places, such as the eye.
Types of eye cancer
Most eye melanomas start in an area of the eye called the uvea. This is called uveal melanoma. It is the most common type of cancer to affect the eye, although it is still quite rare. Between 700 and 800 people are diagnosed with uveal melanoma in the UK each year.
Very rarely, melanoma starts in the conjunctiva, which is the outer lining of the eye. This is called conjunctival melanoma.
These two types of eye melanoma are treated in slightly different ways.
Eye melanoma does not always cause symptoms. It may be found by an optician during a routine eye test.
If you do have symptoms they may include:
- blurred vision
- seeing flashing lights and shadows
- brown or dark patches on the white area of the eye.
These symptoms can be caused by other eye conditions, but tell your GP or optician if you notice them.
The cause of eye melanoma is not known. But there are risk factors that can increase your chance of developing it.
The main risk factor for skin melanoma is exposure to ultraviolet (UV) rays. This can be through natural light from the sun, or through artificial light used in sunbeds or sunlamps. But it is still not clear whether there is a link between UV ray exposure and eye melanoma.
Eye melanoma is more common in people with:
- fair or red hair
- blue eyes
- skin that burns easily.
Eye melanoma is also more common in people who have atypical mole syndrome, which is also called dysplastic naevus syndrome. People with this condition often have more than 100 moles on their body and are more likely to develop a skin melanoma.
Conjunctival melanoma usually develops from a rare condition called primary acquired melanosis (PAM), which causes brown or dark patches (pigmentation) on the conjunctiva. Sometimes the melanoma will develop from an existing freckle or mole on the conjunctiva.
You usually start by seeing your optician or GP. If they are unsure what the problem is, they will refer you to see a specialist at the hospital. An specialist eye doctor is called an opthalmologist.
At the hospital, the opthalmologist will examine you. You may have some of the following tests:
- checking your eye
- an ultrasound scan
- a fluorescein angiography
- a biopsy.
You may have other tests to help plan your treatment or to check how effective treatment has been. We have more information about tests for eye cancer.
The results of your tests helps your doctors find out more about the size and position of the cancer and whether it has spread. This is called staging.
A doctor decides the grade of the cancer by how the cancer cells look under the microscope. This gives an idea of how quickly the cancer might grow or spread.
Knowing the stage and grade helps your doctors plan the best treatment for you.
A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).
Your doctor or cancer specialist will explain the different treatments and their side effects. They will also talk to you about things to consider when making treatment decisions.
Treatment for eye melanoma may include:
Transpupillary thermotherapy (TTT)
Rarely, this can be used to treat very small uveal melanomas, or after radiotherapy to reduce the risk of the cancer coming back. The doctor gives you a local anaesthetic, then uses a type of laser to destroy the cancer cells by heating them. You may need more than one treatment. You can usually go home a few hours after treatment.
This can be given after surgery to reduce the risk of conjunctival melanoma coming back. The doctor freezes the area to kill any cancer cells that may have been left behind after surgery. You may have a local or a general anaesthetic for this treatment.
Chemotherapy eye drops
Sometimes you are given chemotherapy eye drops after cryotherapy for conjunctival melanoma. Your doctor or specialist nurse will explain how to use the eye drops. The drops may make your eye and eyelid red and sore. Let your doctor know if this happens so they can help.
Photodynamic therapy (PDT)
PDT may sometimes be used to treat some uveal melanomas. This treatment uses a laser, or other light sources, combined with a light-sensitive drug to destroy cancer cells. The doctor gives you the drug as an injection into your vein. This makes cells in your body more sensitive to light. The doctor then directs a light at the eye tumour. This activates the drug and the cancer cells are destroyed. This treatment is painless, but you will be sensitive to light for several days after treatment. PDT is not widely available and may only be used as part of a clinical trial.
After treatment for eye melanoma you will see your ophthalmologist and specialist nurse again for a follow-up appointment. You will probably have regular checks for a few years. Your doctor or specialist nurse will explain how often you will see them.
Your doctor or specialist nurse will check your eye and the surrounding area. You may have scans or x-rays to check both the eye and other parts of the body. If you have any problems or notice any new symptoms between these appointments, tell your doctor. You do not need to wait until your next appointment.
Eye melanoma can sometimes spread to other parts of the body. The most common place is the liver, but it can also spread to the lungs and bones. It is important to tell your specialist if you notice any new symptoms, wherever they are in the body, in case further treatment is needed.
Your feelings about eye cancer
You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation.
Macmillan is also here to support you. If you would like to talk, you can:
- Call the Macmillan Support Line on 0808 808 00 00.
- Chat to our specialists online.
- Visit our eye cancer forum to talk to people who have been affected by eye cancer, share your experience, and ask an expert your questions.
Some people with a rare cancer find it helpful to talk to someone with the same condition. Your doctor may be able to put you in touch with someone. You may find it helpful to contact:
- OcuMel UK
OcuMel UK provides information and support for people affected by ocular melanoma.
- Melanoma UK
Melanoma UK provides support and information for patients, carers and healthcare professionals.