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Eye Cancer: Uveal Melanoma

MD Anderson’s experts offer customized care for uveal melanoma, a rare type of cancer of the eye. It is the most common eye cancer in adults and accounts for about 5% of melanoma cases.
The uvea is behind the sclera (the white of the eye) and the cornea, the window at the front of the eye. The uvea has three parts, including the:

  • Iris, the colored part of the eye
  • Ciliary body, a ring of tissue with muscle fibers that change the size of the pupil and the shape of the lens
  • Choroid, also known as the posterior uvea, is the back part of the eye under the retina

According to the American Cancer Society, about nine of 10 melanomas of the eye develop in the choroid.

Uveal Melanoma Symptoms

Uveal melanoma often does not cause symptoms, and many cases are found during routine eye exams. If you do have symptoms, they may include:

  • A dark spot on the iris
  • A change in the shape of the pupil
  • lurred vision or other change in vision
  • Glaucoma
  • Eye pain
  • Eye redness

Uveal Melanoma Diagnosis

A professional eye exam is the main method used to diagnose uveal melanoma. Other diagnosis tools include:

  • Ultrasound
  • Fluorescein angiography, which examines the blood vessels and flow of blood inside the eye

Uveal Melanoma Treatment

The treatment for uveal melanoma depends on several factors. The experts at MD Anderson will customized your treatment especially for your situation.
Treatment of uveal melanoma may include:

  • Surgery
  • Radiation
  • Proton therapy
  • Radiosurgery

MD Anderson offers clinical trials (research studies) for patients with uveal melanoma. Ask your doctor for more information or visit our clinical trial database.

Uveal Melanoma Prevention

Risk factors for intraocular melanoma include being:

  • Exposed to natural or artificial sunlight (such as tanning beds) over long periods of time
  • Fair-skinned with light-colored eyes
  • Older age
  • White

No known inherited genetic mutation is known to cause uveal melanoma. However, MD Anderson is researching families in which uveal melanoma occurs and a gene mutation known as BAP1.
Regular eye examinations by an ophthalmologist are the best way to find uveal melanoma early, when chances for successful treatment are the highest.

If you have been diagnosed with eye cancer, we’re here to help. Call 1-877-632-6789 to make an appointment or request an appointment online.

Why Choose MD Anderson?

  • Latest eye cancer treatments, including specialized surgical techniques to remove cancer but save the eye, proton therapy, targeted therapies, advanced reconstructive surgery for eyelid and orbital cancer
  • Advanced diagnostic techniques including sentinel lymph node biopsy, ultrasound biomicroscopy, confocal biomicroscopy and optical coherence tomography (OCT)
  • Skilled, highly specialized eye surgeons and reconstructive surgeons who have dedicated many years of their career to exclusively treat cancer
  • We treat more eye cancers than most centers
  • Team approach to treating eye cancers
  • Clinical trials of leading-edge treatments for eye cancer

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Uveal Melanoma Staging

(source: American Joint Committee on Cancer)

If you are diagnosed with eye cancer, your doctor will determine the stage of the disease. Staging is a way of classifying how much disease is in the body and where it has spread when it is diagnosed. This information helps your doctor plan the best type of treatment for you. Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.

The most common staging system used for ocular cancers was developed by the American Joint Committee on Cancer (AJCC).  The TNM system is based on three key pieces of information:

  • T describes the size of the primary tumor and/or whether it has invaded nearby structures
  • N describes whether the cancer has spread to nearby (regional) lymph nodes
  • M indicates whether the cancer has metastasized (spread) to other parts of the body (The most common site of eye melanoma spread is the liver)

Numbers or letters appear after T, N and M to provide more details about each of these factors:

  • The numbers 0 through 4 indicate increasing severity
  • The letter X means "cannot be assessed" because the information is not available.

The N and M categories are the same for all uveal melanomas (iris, ciliary body or choroid). The T categories, however, are different for these locations.

T categories for iris melanoma:

  • TX: The main (primary) tumor cannot be assessed; information not known
  • T0: No evidence of a primary tumor
  • T1: Tumor is only in the iris
  • T1a: The tumor is only in the iris and touches 1/4 or less of the iris
  • T1b: The tumor is only in the iris and touches more than 1/4 of the iris
  • T1c: The tumor is only in the iris and is causing an increase in the eye pressure (glaucoma)
  • T2: Tumor has grown into the ciliary body or choroid (or both)
  • T2a: Tumor has grown into the ciliary body and/or choroid and is causing glaucoma
  • T3: Tumor has grown into the ciliary body and/or choroid and into the sclera
  • T3a: Tumor has grown into the ciliary body and/or choroid and into the sclera and is causing glaucoma
  • T4: Tumor extends outside the eyeball
  • T4a: The part of the tumor that is outside the eyeball is 5 millimeters (about 1/5 of an inch) or less across in size
  • T4b: The part of the tumor that is outside the eyeball is greater than 5 millimeters (about 1/5 of an inch) in size

T categories for ciliary body and choroidal melanoma: 

  • TX: The main (primary) tumor cannot be assessed; information not known
  • T0: No evidence of a primary tumor
  • T1: Tumor size is either:
    • No more than 3millimeters deep and no more than 12 millimeters across, OR
    • From 3.1 to 6 millimeters deep and no more than 9 millimeters across
  • T1a: The tumor is T1 in size and is not growing into the ciliary body or growing outside the eyeball
  • T1b: The tumor is T1 in size and is growing into the ciliary body
  • T1c: The tumor is T1 in size and is not growing into the ciliary body but is growing outside of the eyeball. The part of the tumor that is outside the eyeball is 5millimeters (about 1/5 of an inch) or less across in size
  • T1d: The tumor is T1 in size and is growing into the ciliary body. It is also growing outside of the eyeball. The part of the tumor that is outside the eyeball is 5millimeters (about 1/5 of an inch) or less across in size
  • T2: Tumor size is one of the following:
    • No more than 3millimeters deep and from 12.1 to 18.0 millimeters across
    • From 3.1 to 6 millimeters deep and 9.1 to 15 millimeters across
    • From 6.1 to 9.0 millimeters deep and no more than 12.0 millimeters across
  • T2a: The tumor is T2 in size and is not growing into the ciliary body or growing outside the eyeball
  • T2b: The tumor is T2 in size and is growing into the ciliary body
  • T2c: The tumor is T2 in size and is not growing into the ciliary body but is growing outside of the eyeball. The part of the tumor that is outside the eyeball is 5millimeters (about 1/5 of an inch) or less across in size
  • T2d: The tumor is T2 in size and is growing into the ciliary body. It is also growing outside of the eyeball. The part of the tumor that is outside the eyeball is 5millimeters (about 1/5 of an inch) or less across in size
  • T3: Tumor size is one of the following:
    • 3.1 to 6 millimeters deep and between 15.1 and 18 millimeters across
    • 6.1 to 9.0 millimeters deep and between 12.1 and 18 millimeters across
    • From 9.1 to 12 millimeters deep and 18 millimeters or less across
    • From 12.1 to 15 millimeters deep and 15 millimeters or less across
  • T3a: The tumor is T3 in size and is not growing into the ciliary body or growing outside the eyeball
  • T3b: The tumor is T3 in size and is growing into the ciliary body
  • T3c: The tumor is T3 in size and is not growing into the ciliary body but is growing outside of the eyeball. The part of the tumor that is outside the eyeball is 5millimeters (about 1/5 of an inch) or less across in size
  • T3d: The tumor is T3 in size and is growing into the ciliary body. It is also growing outside of the eyeball. The part of the tumor that is outside the eyeball is 5millimeters (about 1/5 of an inch) or less across in size.
  • T4: Tumor size is one of the following:
    • Greater than 15 millimeters deep and any width
    • Greater than 18 millimeters across and any depth
    • Between 12.1 and 15.0 millimeters deep and between 15.1 and 18 millimeters across
  • T4a: The tumor is T4 in size and is not growing into the ciliary body or growing outside the eyeball
  • T4b: The tumor is T4 in size and is growing into the ciliary body
  • T4c: The tumor is T4 in size and is not growing into the ciliary body but is growing outside of the eyeball. The part of the tumor that is outside the eyeball is 5millimeters (about 1/5 of an inch) or less across in size
  • T4d: The tumor is T4 in size and is growing into the ciliary body. It is also growing outside of the eyeball. The part of the tumor that is outside the eyeball is 5millimeters (about 1/5 of an inch) or less across in size
  • T4e: The tumor is growing outside the eyeball with the part of the tumor that is outside the eyeball greater than 5millimeters across. The tumor can be any size.

N categories for iris, ciliary body and choroidal melanomas:

  • NX: Lymph nodes cannot be assessed
  • N0: Cancer has not spread to nearby lymph nodes
  • N1: Cancer has spread to nearby lymph nodes.

M categories for iris, ciliary body, and choroidal melanomas:

  • M0: Cancer has not spread to distant parts of the body
  • M1: Cancer has spread to distant parts of the body
  • M1a: The largest area of cancer spread is 3 centimeters (a little over an inch) across or smaller
  • M1b: The largest area of cancer spread is between 3.1 and 8 centimeters across (8 centimeters is a little over 3 inches)
  • M1c: The largest area of cancer spread is 8 centimeters or more across.

© 2014 The University of Texas MD Anderson Cancer Center