Uveal Melanoma


What is Uveal melanoma?

Uveal melanoma is a rare syndrome, but a familiar key term used for adults who are suffering from  intraocular malignancy. Uveal tract is the middle part of the eye and consist of the choroid, ciliary body, and iris are the parts of the uveal tract. All the parts or any one part can involve in uveal melanoma.

uveal melanoma


uveal melanoma

Uveal tract is the middle layer of the anatomy of the eye and rich in melanin productive (pigmenting) cells. Uveal melanoma is caused by the metastasis in melanin producing cells. The metastasis of the uveal melanoma can also stretch to the distant organs, which include liver, pursued to the lungs and soft tissue sites.

The metastasis of uveal melanoma are extended to distant organ with increasing of time, and usual findings refer that after 5 years of onset of primary tumor 25%  of cases metastasis spread to distant parts, whereas it raises 34% after 10 years.

Therefore, it is considered that Uveal melanoma is a symptomatic disease with poor prognosis. (1, 2)

Causes

The proper cause of development of the uveal melanoma is not yet understandable, though different studies linked up the risk of uveal melanoma with exposure to sunlight. But in extent, no evidence based research data obtain to support this statement.


Associated risk factors

Some identified clinical conditions increase the risk of uveal melanoma, which include unusual mole syndrome, oculodermal melanocytosis and dysplastic nevus syndrome.

In addition,


  • Fair complexion, which has a tendency to develop light brown skin patch in exposure to sunlight or burns simply, but tans does not produce and/ or poorly tans.
  • Eye color is green or blue or other light-colored eyes.
  • Increased age
  • White skinned individual (4)

Sign and symptoms

In the early stage of uveal melanoma is asymptomatic and usually identified during routine eye check up. The following general sign and symptoms may influence individual to eye check up:

  • Vision related problem or hazy vision
  • Experience of floaters means in the vision field feeling of dusty spots or light also flash with periodic interval.
  • Inside the iris a dark spot is produced
  • Pupil of the eye alters in respect of shape and size
  • Location of the eyeball changes in the eye orbit

But the above mentioned symptoms may not prominent at an early stage. The metastasis of the uveal melanoma are spread to distant organ and the survival rate of the affected individual becomes lower. Study results showed that the after diagnosis of metastasis, average survival time is 51 months. (2, 3, 4)

Diagnosis

The following diagnostic tests possibly conducted to detect the uveal melanoma:

Medical history analysis and physical examination

It is very important to thorough knowledge of patient’s medical history, including past aliments, chronic disease condition and followed treatment regimen. General health of the patient is examined through physical examination.

Eye examination

For detail eye examination doctors provide an eye drop to the eyes for dilating the pupil size. Enlarged pupils allow to examine the eye thoroughly. Different technique is used to examine the eye. Initially doctors check the eye through lens.


uveal melanoma

uveal melanoma image

Apart from this, ophthalmoscopy (to test the retina and optic nerve by using a minute magnifying lens and a light), Slit-lamp biomicroscopy (to check the retina, optic nerve, and other internal parts of the eye by using a microscope and a strong beam of light) and Gonioscopy (to check the blockage of the eye fluid drainout process by using a special instrument).

Ultrasound exam of the eye

A sonogram is the picture obtained through ultrasound passed through the internal tissues of the eye, which provide an inner picture of the eye and the distance from the cornea to the retina.

High-resolution ultrasound biomicroscopy

Ultrasound wave passes through the internal tissues of the eye, this is a sophisticated test rather than the regular ultrasound, which can provide size, shape, and thickness of the tumor and the tendency of the metastasis to spread the nearby tissue.

Transillumination of the globe and iris

In this test, the light is placed on either the upper or lower lid of the eye and examine the iris, cornea, lens, and ciliary body.

Fluorescein angiography

In this test injecting fluorescein (an orange fluorescent dye) to check the blood vessels and the blood circulation inside the eye.

Indocyanine green angiography

Indocyanine green dye is injected to check the blood vessels in the choroid layer of the eye and also check the obstruction or dripping areas of the retina and choroid.

Ocular coherence tomography

This is an imaging test, in which light waves are applied to get cross-section images of the retina and also involved the choroid, to observe if there is any inflammation or fluid retention present under the retina. (1)

Treatment

The treatment process depends upon the size and site of the malignant tumor. The treatments may plan for patients are:

  • Radiation therapy
  • Laser therapy
  • Surgery: Extensive surgery means removing the complete eye (enucleation) is applied to the large size tumor.

Recurrent melanomas

In case of recurrent uveal melanoma, chemotherapy, targeted therapy and immunotherapy may add in the therapeutic regimen for the control the recurrence. (3, 4)

References

1. Intraocular (Uveal) Melanoma Treatment (PDQ®)–Health Professional Version (2015); National cancer institute; Retrieve from: http://www.cancer.gov/types/eye/hp/intraocular-melanoma-treatment-pdq

2. Dominic M Buzzacco,§,1 Mohamed H Abdel-Rahman,§,1,2 Stanley Park,1 Frederick Davidorf,1 Thomas Olencki,3 andColleen M Cebulla*, Long-Term Survivors with Metastatic Uveal Melanoma; Open Ophthalmol J. 2012; 6: 49–53; Retrieve from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394198/

3. Eye Cancer (Melanoma and Lymphoma); Treating uveal (eye) melanoma by location and size (2014); American Cancer Society; Retrieve from: http://www.cancer.org/cancer/eyecancer/detailedguide/eye-cancer-treating-uveal-melanoma

4. Hakan Demirci; Uveal Melanoma (Eye Cancer); Retrieve from: http://www.kellogg.umich.edu/patientcare/conditions/uveal.melanoma.html

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