Eye cancer is rare. About 850 people are diagnosed with eye cancer in the UK each year. There are different cancers that can affect the eye. Eye melanoma is the most common type. It is also called ocular melanoma.
Melanoma s a cancer that develops from cells called melanocytes. Melanocytes give our skin its colour, and melanoma usually develops in the skin. But because there are melanocytes in different parts of the body, melanoma can start in other places, such as the eye.
This information is about eye melanoma.
The eye is made up of different layers of tissue and filled with a clear jelly. Different parts of the eye work together to help us see.
The conjunctiva is a thin, clear lining that covers and protects the white outer surface of the eye and the inside of the eyelids.
The uvea is the middle layer around the eyeball. It controls how light comes into the eyeball and helps the eye to focus. It also makes a fluid around the lens (the clear inner part of the eye). This fluid keeps your eye healthy.
The uvea includes the following parts:
- The iris, which is the coloured disc at the front of your eye. It controls the light entering the eye.
- The ciliary body, which makes the fluid around the lens. This keeps your eye healthy and able to focus.
- The choroid, which lines the back of the eye. It contains blood vessels which provide nutrients to the retina.
Types of eye cancer
There are 2 main types of eye melanoma:
- Uveal melanoma, which starts in the uvea. This is the most common type of eye melanoma. It usually affects the choroid or sometimes the ciliary body. It rarely affects the iris.
- Conjunctival melanoma, which starts on the conjunctiva. This is a rarer type of eye melanoma.
Eye melanoma does not always cause symptoms. It may be found by an optician during a routine eye test.
Uveal melanoma symptoms may include:
- blurred vision
- seeing flashing lights or balls of lights
- seeing shadows.
Conjunctival melanoma symptoms may include:
- new brown or dark patches appearing on the white area of the eye
- existing brown or dark patches on the white area of the eye getting bigger
- a raised, skin-coloured bump on the white of the eye.
These symptoms can be caused by other eye conditions. But if you have any of these or any other eye changes, tell your GP or optician straight away.
Doctors do not know what causes eye melanoma. But there are risk factors that can increase the chance of developing it.
Skin and hair type
Uveal melanoma is more common in people with:
- skin that burns easily
- fair or red hair
- blue eyes.
It is rare in people with brown eyes or if you are Black or Asian.
UV ray exposure
The main risk factor for skin melanoma is exposure to ultraviolet rays (UV rays). But it is not clear whether there is a link between UV ray exposure and uveal melanoma. There is some evidence linking conjunctival melanoma to exposure to UV rays through sunlight, sunbeds or sunlamps.
Atypical mole syndrome
Eye melanoma is more common in people who have atypical mole syndrome. People with this condition usually have more than 100 moles on their body.
Primary acquired melanosis (PAM)
Conjunctival melanoma usually develops from a rare condition called primary acquired melanosis (PAM). This causes many brown or dark patches (pigmentation) on the conjunctiva, usually in one eye. PAM can be monitored so that any signs of it changing are found early and treated.
Sometimes the melanoma develops suddenly. But it can also 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 a specialist eye doctor at the hospital. This doctor is called an ophthalmologist.
If the ophthalmologist thinks you have eye melanoma, they will refer you to a national eye cancer centre straight away. These are based in eye hospitals or in a general hospital, depending on where you live.
At the hospital, a doctor will examine your eye using a small handheld lens and light. This is called an ophthalmoscope. Or they may ask you to look into a large microscope that sits on a table.
Eye tests can include taking photographs, scans and ultrasounds of the eye. You may have a test called an eye angiogram to check the blood vessels at the back of the eye (retina). It is rare to need a biopsy to diagnose eye cancer. But it may be done in some situations.
We have more detailed information about:
The results of your tests help your doctors find out more about the size and position of the cancer and whether it has spread. This is called staging. Knowing the stage helps your doctors plan the best treatment for you.
TNM staging system
The TNM staging system is commonly used for eye melanoma. TNM stands for tumour, nodes, metastases.
T describes the size of the tumour and whether it has grown into other parts of the eye (intraocular) or areas outside the eyeball (extraocular). It also measures the thickness and width of the eye melanoma.
N is whether the cancer has spread to lymph nodes near the eye.
- N0 means the cancer cells are not in the nearby lymph nodes.
- N1 means there are cancer cells in the lymph nodes. It is more common for conjunctival melanoma to spread to nearby lymph nodes.
M is whether the cancer has spread to another part of the body. This is called metastatic cancer.
- M0 means the cancer has not spread.
- M1 means the cancer has spread to other organs, such as the liver.
Your doctor or nurse may describe the tumour as small, medium or large. Or they may describe it as:
- early or localised – this is eye melanoma that has not spread outside the eye
- advanced – this is eye melanoma that has spread to areas outside the eye, or to the liver or lungs.
A team of specialists will meet to discuss and plan the best treatment for you. This team is called a multidisciplinary team (MDT). Eye melanomas are treated at special centres in only a few hospitals in the UK.
Your cancer doctor and nurse will explain the different treatments and their side effects. They will talk to you about things to think about when making treatment decisions. You and your doctor can then decide on the best treatment for you.
The aim of treatment is to destroy the cancer cells, while doing as little damage as possible to your eyesight. Uveal and conjunctival melanomas are treated in different ways.
Your treatment plan will depend on:
- the type of eye melanoma you have
- the size and position of the tumour
- your general health
- your eyesight.
The most common treatment for uveal melanoma is radiotherapy. This is usually very effective. Surgery is more commonly used to treat conjunctival melanoma. You may have a combination of treatments.
If eye melanoma has spread to other parts of the body, you may have treatment with immunotherapy and targeted drugs. Sometimes it is possible to remove a small area of spread with surgery.
Treatment for eye cancer may include:
Radiotherapy uses high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells. The most common way of giving radiotherapy for eye cancer is by putting a small radioactive disc on the outside of the eye. This is called brachytherapy.
Radiotherapy can also be given from a radiotherapy machine outside the body. This is called external radiotherapy. It includes using specialised techniques, such as stereotactic radiation therapy and proton beam radiotherapy.
Radiotherapy can cause side effects during treatment and for a few weeks after. It may also cause some long-term effects. Your doctor and nurse will explain the side effects.
Surgery is not always needed to treat eye cancer. It is the most common treatment for conjunctival melanoma. The surgeon removes the tumour from the surface of the eye as well as a small amount of surrounding healthy conjunctiva. This is called local resection. You rarely have surgery for uveal melanoma.
Sometimes doctors advise removing the whole eye. This is only when they are certain it is the best treatment for you. It may be done if the tumour is too large to be treated with radiotherapy or if the eye becomes painful after radiotherapy.
You may have other treatments on their own or with surgery or radiotherapy:
You may have cryotherapy to reduce the risk of conjunctival melanoma coming back. The doctor freezes the area to kill any cancer cells that may remain after surgery. You may have a local or general anaesthetic for this treatment.
Chemotherapy or immunotherapy eye drops
You may have chemotherapy or immunotherapy eye drops for conjunctival melanoma. You may have these before or after surgery. Your doctor or specialist nurse will explain how to use the eye drops. The drops may make your eye and eyelid red and sore. Tell your doctor or nurse if this happens.
Photodynamic therapy (PDT)
Photodynamic therapy (PDT) may be used to treat small uveal melanomas. It uses a laser, or other light sources, combined with a light-sensitive drug, to destroy the melanoma cells.
This treatment is painless and only takes a few minutes. But you will be sensitive to light for several days after treatment. You may have up to 3 PDT treatments with 1 month between treatments.
Advanced eye cancer is when the cancer has spread to another part of the body or comes back after treatment. The treatment you have will depend on where it has spread to and treatments you have already had.
If melanoma comes back in the eye, it is called a local recurrence. This usually needs to be treated with surgery to remove the eye. If conjunctival melanoma comes back in the same area, you may have surgery to remove the lymph nodes in the neck.
If uveal melanoma comes back in the liver it is called secondary liver cancer. There are different treatments that can be used.
A new immunotherapy drug called tebentafusp or Kimmtrak® may be used to control uveal melanoma. It has been shown to help people with advanced uveal melanoma to live for longer.
Sometimes targeted drugs may be used to treat advanced conjunctival melanoma.
We have more information about treating advanced eye cancer.
At the end of treatment, your doctors and nurses will talk to you about what to expect. They will also tell you about follow-up care you may need. You may still have side effects from treatment and other emotions to cope with. It takes time to recover.
For some people, treatment for eye cancer changes their appearance. This can affect their body image. If you have changes that are hard to adjust to, talk to your nurse or doctor. They may be able to refer you for specialised help.
Cancer and its treatment can also affect your sex life. You can read more about coping with this in our information about cancer and sex.
After treatment for eye melanoma, you will have regular appointments with your specialist eye doctor and nurse. They will explain how often you will have appointments.
At your appointments, they will check your eye and the surrounding area. Your doctor will also ask you about treatment side effects you may be having.
You may have scans or x-rays to check the eye. Some people have regular blood tests and scans to check their liver and other organs.
Contact your specialist doctor or nurse straight away if you have any problems or notice new symptoms anywhere in the body. You do not need to wait until your next appointment.
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 fior free on 0808 808 00 00.
- Chat to our specialists online.
- Visit our eye cancer forum to talk with 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 also find it helpful to contact:
Melanoma UK provides information, guidance and support for patients, carers and healthcare professionals. It provides a free helpline run by expert nurses. It also has a Melanoma TrialFinder for melanoma clinical trials in the UK.
Well-being and recovery
Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes after treatment.
Making small changes such as eating well and keeping active can improve your health and wellbeing and help your body recover.
Below is a sample of the sources used in our eye cancer (ocular melanoma) information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
Jain P, Finger PT, Fili M, et al. Conjunctival melanoma treatment outcomes in 288 patients: a multicentre international data-sharing study. British Journal of Ophthalmology 2021;105:1358–1364. (accessed May 2022).
Nathan, Paul, Hassel, Jessica C, et al. Overall Survival Benefit with Tebentafusp in Metastatic Uveal Melanoma. New England Journal of Medicine, 2021, 385(13):1196-1206. (accessed May 2022).
Jessica Yang, Daniel K. Manson, et al. Treatment of uveal melanoma: where are we now? Therapeutic Advances in Medical Oncology. 2018, Vol. 10: 1–17. (accessed May 2022).
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Samra Turajlic, Consultant Medical Oncologist.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.
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