Uveal Melanoma
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- What is Uveal Melanoma
- Symptoms
- Treatments of primary
- Treatments of Melanoma that has spread
- Clinical trials
- Best supportive care
What is Uveal Melanoma?
Ocular melanoma is a cancer of the eye. Melanomas form in the pigment-producing cells in the body. These cells, called melanocytes, give our eyes and skin their colour.
Symptoms of Uveal Melanoma
Not all ocular melanomas cause symptoms. Because of this, these cancers are often found during a routine eye test. Sometimes, you may visit your optician or optometrist because you have some symptoms.
Other common conditions can also cause these symptoms. It is important to have regular eye tests and have any changes to your vision checked by your GP or optometrist.
common symptoms of uveal melanoma include:
- Blurred vision
- Seeing shadows
- Seeing lights
- Seeing floaters
- Pain in the eye (rare)
Treatments for primary Uveal Melanoma
ye cancer can sometimes spread to nearby areas by growing directly through the tissue. Or, if cancer cells from the eye break away and travel to a new location. You will often hear the term metastases, metastatic disease, or secondaries when doctors are talking about cancers that have spread away from the eye.
Your doctor will recommend treatment to control your cancer and slow down its spread. There are two main types of treatment to control cancer: targeted treatments and systemic treatments. Treatments will also differ based on the type of eye melanoma you have.
Radiotherapy
Radiotherapy is one of the main treatments for ocular melanomas. Radiation stops the cancer cells from growing or making more cancer cells, causing the tumour to shrink and die.
In the UK, you are most likely to receive plaque radiotherapy or proton beam therapy for uveal melanomas. In some cases, stereotactic radiotherapy may also be offered. There is no single best form of radiotherapy for eye cancers – each has its benefits and risks, including side effects.
Radiotherapy may be an option for you if you have conjunctival melanoma too. However, surgery is more commonly used to treat these cancers. Depending on your circumstances, your doctor will suggest the best options for you.
Plaque radiotherapy(sometimes called plaque brachytherapy)
When you undergo plaque radiotherapy, a small, thin metal disc is temporarily attached to the surface of the affected eye, overlying the cancer cells. If this treatment is offered to you, you will stay in the hospital for around a week and have two surgeries on your eye:
- The first surgery is to attach the plaque to your eye
- The second surgery follows a few days later, to remove the plaque before you are discharged.
Your doctor will perform both operations under anaesthesia, so you should feel no pain or discomfort during the surgery.
Learn more about plaque radiotherapy and its side effects, including how it is given, how you can prepare for treatment, and some practical tips in our plaque radiotherapy booklet.
Proton beam therapy
Proton beam therapy uses an external machine to deliver a beam of radiation directly to the cancer in your eye.
Before starting treatment, you must attend an assessment and planning visit at Clatterbridge Oncology Centre. You will then receive your treatment at the Centre usually a couple of weeks later. Treatment is given in doses over a few days, each daily treatment taking up to an hour.
Proton beam therapy is painless. Your medical team will tell you more about what to expect during treatment.
Learn more about proton beam therapy and its side effects, including how it is given, how you can prepare for treatment, and some practical tips in our proton beam therapy booklet..
Stereotactic radiotherapy
Stereotactic radiotherapy uses special equipment to deliver radiation directly to the cancer in your eye. The machine used to deliver treatment is sometimes called a “GammaKnife machine”.
Stereotactic radiotherapy is only offered via the Sheffield Ocular Oncology Service and is not suitable for everyone. It is useful for treating tumours wrapped around the optic nerve.
Learn more about stereotactic radiotherapy and its side effects on the Sheffield Teaching Hospital’s website.
Surgery
Local resection
If you have conjunctival melanoma, you may get surgery to remove the tumour and a small amount of healthy conjunctiva. This is called a local resection.
Learn more about local resections on the Moorfields Eye Hospital website.
Enucleation
Enucleation involves the complete removal of your affected eye to remove the cancer within it. Your doctor may recommend it as a first option if your tumour is too large for other treatment options.
Sometimes, enucleation is recommended if treatment with radiation is not successful. Having enucleation surgery is very personal. While some people prefer to get their affected eye removed to treat their cancer, others may consider this the last option.
Learn more about enucleation, including how you can prepare for surgery and our patient community’s stories and advice on living with one eye in our enucleation booklet.
Watch and wait
Sometimes, your cancer may be slow growing and not require treatment immediately or your doctor may be unsure about whether the growth in your eye is cancer. In these cases, your doctor may recommend the watch-and-wait approach (also sometimes called watchful waiting), before starting treatment.
During the waiting period, eye checkups may be recommended every 3-4 months to monitor any growth. A treatment plan will be made if your medical team have evidence of cancer, such as growth.
Follow up care
After treatment, your medical team will make a plan to monitor changes to your eye. You will be told about any side effects you can expect and how to manage them.
Depending on your cancer type, you may be offered surveillance scans on other parts of your body. These scans may be arranged so that any changes or cancer spread are detected as early as possible.
If you are worried about surveillance scans, have related questions, or have any new symptoms, speak to your medical team. They can guide you.
You can also contact us to talk through what is on your mind and how you can find answers to your questions.
Treatments for Conjunctival Melanoma that has spread
Targeted treatments
Targeted treatments focus on the parts of the body where there is cancer. For example, for uveal melanomas, many treatments will focus on the liver as this is the most common place for it to spread.
Liver surgery
Sometimes, it is possible to remove part of the liver where the cancer is. This surgery is called a liver resection. Different factors affect whether liver resection is an option. Your medical team will talk to you about this.
Radiofrequency ablation (RFA)
Radiofrequency ablation (RFA) uses heat to kill cancer cells. Radio waves are a type of energy that can be used to heat up tissues inside the body. When they are focused on cancer cells, they can kill them.
Microwave ablation (MWA)
Microwave ablation (MWA) uses microwave energy instead of radio frequency energy. Surgeons use it to heat the liver and damage cancer cells.
Hepatic Artery Embolisation (HAE) or Hepatic Artery Chemo-Embolisation (HAC)
Hepatic artery embolisation (HAE) uses microscopic gel beads to block off the blood vessels feeding tumours inside the liver.
Hepatic artery chemo-embolisation (HAC) combines chemotherapy and hepatic artery embolisation, by soaking the embolisation beads in a strong chemotherapy solution. It is also known as HAC and TACE (transarterial chemo-embolisation).
Chemosaturation
If surgery is not an option, you may receive chemotherapy directly to the liver. Doctors can isolate the liver from the rest of the body’s blood circulation to deliver strong chemotherapy to treat the cancer.
This treatment has a number of names, including hepatic arterial infusion of chemotherapy, hepatic chemosaturation, chemosaturation therapy, and percutaneous hepatic perfusion (PHP). You may also hear the brand names Chemostat or Delcath.
Currently, this treatment is only available privately in the UK. NHS England is currently reviewing whether it should be available on the NHS for people with ocular melanoma. Your medical team will be able to tell you more about this.
Radioembolisation
This treatment involves injecting tiny, microscopic radioactive beads called microspheres into your liver. The beads lodge themselves in the tiny blood vessels surrounding the tumours in the liver. They give off high doses of radiation that shrink the tumours.
Doctors also call this treatment selective internal radiotherapy or use the brand name SIR-spheres.
Currently, this treatment is not routinely available on the NHS for people with ocular melanoma.
Systemic treatments
A systemic treatment is designed to treat cancer cells anywhere in the body, rather than being focused on one organ, e.g. the liver. They can also help people whose cancer has spread to more than one area or when targeted treatments are not an option.
Immunotherapy
Immunotherapy uses your own immune system to attack the cancer cells. There are different types of immunotherapies.
Checkpoint Inhibitors
Checkpoint inhibitors work by helping the immune system attack cancer cells. For ocular melanomas, you will receive an intravenous drip (infusion) of drugs like ipilimumab, nivolumab and pembrolizumab.
Read more about checkpoint inhibitors on Macmillan Cancer Support’s page.
Tebentafusp
Tebentafusp is an anti-cancer medication that is given through a drip (infusion). You might also hear it called KIMMTRAK or IMCgp100.
To qualify for this treatment, you must test positive for certain HLA (Human Leukocyte Antigen) markers in genes involving your immune system. A blood test can confirm if you are HLA-A*02:01-positive.
Other types of immunotherapy
TILs and CAR-T are related therapy approaches. In both cases, immune cells are harvested and grown outside the body and then returned to the patient as a cancer treatment.
In TILs, these cells are the patients’ own unmodified cells. In CAR-T, these cells are genetically modified and may come from a donor.
Not enough evidence is currently available to suggest these treatments could help people with ocular melanoma. The NHS does not currently fund these.
Immunotherapy
Chemotherapy
Chemotherapy uses anti-cancer drugs to kill cancer cells anywhere in the body. It is rarely considered for people with ocular melanomas as it is less effective at treating this type of cancer, compared to other cancers.
If you are offered chemotherapy, such as Dacarbazine, your medical team will provide more information about this treatment.
Clinical trials
Clinical trials are medical research studies involving patients. They allow researchers to find better treatments for people with ocular melanoma.
They may compare new treatments to current ones to see if they work and are safe. They will also examine side effects and whether the treatments help people feel better.
You can also ask your doctor if there are any trials you could join.
Find out about current clinical trials on our Clinical Trials page.
Best supportive care
Besides treatments to control the spread of cancer, you can also have best supportive treatments to manage any symptoms. You may hear this called symptom control or palliative care.
It aims to make you feel as well as possible so that you can manage daily life, including controlling symptoms, managing pain, and offering emotional and practical support.
Some people find the thought of palliative care upsetting. But, these services are not just for people at the end of their lives. They are available anytime during your care to help make you more comfortable.
Contact us for support
The Ocular Melanoma UK helpline offers confidential support to people living with Ocular Melanoma and their loved ones.
Call us on 0300 790 0512
Lines open between 10am – 7pm Monday – Friday
Email us
Email us on helpline@omuk.org
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