Ocular Melanoma

Ocular melanoma is a broad term referring to any melanoma occurring within the eye, encompassing different types based on the eye’s anatomy.

Uveal melanoma is the most common and specific type of ocular melanoma, originating from melanocytes in the uvea - the middle layer of the eye, which includes the iris, ciliary body, and choroid.

While all uveal melanomas are ocular melanomas, not all ocular melanomas are uveal; other rare types include conjunctival melanoma, which arises from the eye’s surface tissues.

Uveal melanoma is distinct in its location, behavior, and treatment approaches, often requiring specialized dilated eye examinations and management due to its potential to affect vision and metastasize.

🧿 Ocular Melanoma Fact Sheet

Published July 10, 2025 | By: OcularCancer.com

A Rare but Life-Altering Eye Cancer
Knowledge is Power – Early Detection Saves Lives

📌 What is Ocular Melanoma?

Ocular melanoma is a rare cancer that develops in the eye's pigment-producing cells. The uvea - the middle layer of the eye - contains most of the eye’s melanocytes and is the primary site for this cancer. This form is called uveal melanoma and is the most common type of intraocular (within the eye) cancer in adults.

👁️‍🗨️ Ocular Melanoma Types

Choroidal Melanoma
- Location: Choroid (the vascular layer at the back of the eye, part of the uvea)
- Prevalence: ~85 - 90% of all uveal melanoma cases
- Odds: About 1 in 100,000 per year in the general population
- Notes: This is the most common type of ocular melanoma. It often grows silently until vision is affected or it is found during a routine eye exam.

Ciliary Body Melanoma
- Location: Ciliary body (the ring-shaped part of the uvea behind the iris)
- Prevalence: ~6 - 8% of uveal melanomas
- Odds: Much rarer than choroidal melanoma; fewer than 1 in 1,000,000 per year
- Notes: Often difficult to detect early; may grow larger before diagnosis due to hidden location.

Iris Melanoma
- Location: Iris (the colored part of the eye)
- Prevalence: ~4 - 5% of uveal melanomas
- Odds: Estimated at less than 1 in 5,000,000 per year
- Notes: Usually slow-growing and visible, making early detection more likely; tends to have a better prognosis.

Conjunctival Melanoma
- Location: Conjunctiva (the thin membrane covering the white part of the eye and inner eyelids)
- Prevalence: < 5% of all ocular melanomas (not uveal)
- Odds: Roughly 1- 2 cases per million people per year
- Notes: Behaves similarly to skin melanoma; can spread to lymph nodes and lungs if untreated.

Orbital Melanoma
- Location: Orbit (the socket and tissues surrounding the eyeball)
- Prevalence: Extremely rare
- Odds: Unknown due to its rarity, often related to metastasis or extension from nearby structures
- Notes: May be primary or secondary (spread from another site); typically presents with pain, swelling, or vision changes.

Secondary (Metastatic) Melanoma to the Eye
- Location: Any part of the eye, often the choroid
- Prevalence: Not considered primary ocular melanoma
- Odds: More common in patients with advanced skin melanoma
- Notes: The eye - particularly the choroid - is a common site for metastasis from cutaneous melanoma, breast, or lung cancers.

📊 Statistics

🧬 ~2,000 - 2,500 cases diagnosed annually in the U.S.
🌍 More common in Caucasians, people aged 50 -70
👁️ Accounts for ~5% of all melanoma cases
⚠️ Metastasis in ~50% of cases - especially to the liver
🔬 Median survival after metastasis: ~6 -12 months (research is improving this)

⚠️ Common Symptoms

Uveal melanoma often shows no early symptoms, but can include:

Blurry or distorted vision
Flashes or floaters
Dark spot on the iris
Peripheral vision loss
Change in pupil shape
Pain or pressure (rare)

🧪 How It's Diagnosed

Comprehensive dilated eye exam
Ultrasound of the eye (B-scan)
OCT (optical coherence tomography)
Fundus photography
Fluorescein angiography
MRI, CT, or biopsy if metastasis is suspected

🧬 Risk Factors

Light eye color (blue/green)
Fair skin or tendency to sunburn
Older age
Genetic mutations (e.g., BAP1, GNAQ, GNA11)
Family or personal history of skin melanoma
Certain genetic syndromes (e.g., BAP1 Tumor Predisposition Syndrome)

💉 Treatment Options

Treatment depends on the tumor's size, location, and spread:

Plaque brachytherapy (radioactive disc placed on eye)
Proton beam or gamma knife radiation
Laser photocoagulation (rarely used)
Surgical removal (local resection or enucleation)
Immunotherapy, targeted therapy, or clinical trials (for metastatic cases)

🌱 Living with Ocular Melanoma

Regular liver function tests and imaging to monitor for spread
Emotional support & counseling can help manage stress
Vision changes or loss are possible, even after treatment
Long-term survivorship varies - early detection improves outcomes

💙 Support and Advocacy

Connect with ocular melanoma communities and survivor groups
Participate in clinical trials and research initiatives
Advocate for dilated eye exams and rare cancer funding

👁️‍🗨️ Why Eye Exams Matter

Dilated eye exams are the only way to detect ocular melanoma early, especially if you have no symptoms. Ask your eye doctor to examine the back of your eye and check the choroid.

✅ Recommended: Eye exams every 1 - 2 years for adults; yearly if at high risk.