Choroidal melanoma is a rare eye cancer that requires specialized treatment to preserve vision and prevent the disease from spreading to other parts of the body. While most people never experience symptoms, early detection during routine eye exams can make a significant difference in treatment outcomes and survival.

Understanding Treatment Goals and Options for Choroidal Melanoma

When someone receives a diagnosis of choroidal melanoma, the primary goals of treatment focus on several key areas. First and foremost, doctors aim to prevent the cancer from spreading to other parts of the body, particularly the liver, which is the most common site for this type of melanoma to metastasize. At the same time, treatment plans are designed to preserve the eye itself whenever possible, and to maintain as much vision as the situation allows.^[1]

Treatment decisions depend heavily on the size and location of the tumor within the eye, as well as the patient’s overall health and visual function. A small tumor discovered early might require a very different approach than a larger, more advanced melanoma. The patient’s wishes and quality of life considerations also play an important role in deciding which treatment path to follow.^[2]

There are standard treatments that have been carefully studied and approved by medical societies around the world. These established methods have proven track records in treating choroidal melanoma. However, research continues, and clinical trials are testing new therapies that may offer additional options for patients in the future. Eye cancer specialists can correctly diagnose choroidal melanoma in over 96% of cases without needing to perform a biopsy (a procedure that removes a small piece of tissue for examination).^[4]

Standard Treatment Approaches

Radiation Therapy with Eye Plaques

The most common treatment for choroidal melanoma is a specialized form of radiation therapy called plaque brachytherapy. This technique involves placing a small, disc-shaped device containing radioactive material directly on the outside of the eye, positioned over the tumor. The radioactive plaque delivers a concentrated dose of radiation to the melanoma while minimizing exposure to surrounding healthy tissues.^[11]

Different radioactive materials can be used in these plaques. Iodine-125 is the most commonly used source in the United States, though some centers use ruthenium-106 or palladium-103. Each of these materials has different energy levels and delivers radiation at varying depths, which makes them suitable for tumors of different sizes and locations. The plaque typically remains in place for several days, during which time the patient stays in the hospital. After the calculated radiation dose has been delivered, the plaque is removed in a brief surgical procedure.^[11]

The advantages of plaque therapy are significant. It allows patients to keep their eye, and many people maintain useful vision after treatment. However, the radiation can cause side effects over time. These may include damage to the retina (the light-sensitive tissue at the back of the eye), changes in the lens that lead to cataracts, or inflammation inside the eye. Some patients develop radiation retinopathy, a condition where the blood vessels in the retina become damaged, which can affect vision months or years after treatment.^[18]

External Beam Radiation

Some specialized centers offer external beam radiation techniques, such as proton beam therapy, gamma knife, or stereotactic radiotherapy. These methods deliver focused radiation beams from outside the body, targeting the tumor with high precision. Proton beam therapy, in particular, has been used for decades to treat eye melanomas, especially in Europe and certain centers in the United States.^[11]

External beam methods can be particularly useful for tumors that are difficult to reach with plaques or that are located near sensitive structures like the optic nerve. The treatment is typically delivered over several sessions, and patients do not need to be hospitalized. Like plaque therapy, external beam radiation can cause side effects including vision changes, dry eye, and damage to surrounding eye structures, though the specific risks vary depending on the exact technique used.^[13]

Surgical Removal of the Eye (Enucleation)

Enucleation, the surgical removal of the entire eye, is typically reserved for specific situations. Doctors recommend this approach when the tumor is too large for eye-preserving treatments, when the eye has already lost all useful vision, when there is severe pain from uncontrolled eye pressure, or when the tumor has grown through the wall of the eye into surrounding tissues.^[11]

The procedure involves removing the eye while leaving the muscles and surrounding tissues intact. After healing, patients are fitted with an artificial eye, called an ocular prosthesis, which provides excellent cosmetic appearance. Modern prosthetics are custom-made to match the remaining eye and can move naturally when the patient looks around. Most patients adapt well to life with a prosthetic eye, though they lose depth perception and have a narrower field of vision.^[11]

Laser Treatment

For very small melanomas or certain specific situations, laser treatments may be used. Laser photocoagulation uses focused light energy to destroy tumor cells by heating them. This approach is generally reserved for small tumors located in specific areas of the eye where laser treatment can be safely applied without damaging critical structures. Laser therapy may also be used as an additional treatment alongside radiation in some cases.^[11]

Local Tumor Resection

In select cases, surgeons may perform local resection, which involves surgically removing the tumor while leaving the eye in place. This technique is technically demanding and requires specialized expertise. It can be considered for certain tumors based on their size and location. The procedure carries risks including bleeding, retinal detachment, and infection, but may offer an alternative to removing the entire eye in carefully selected patients.^[11]

Treatment in Clinical Trials

Research into new treatments for choroidal melanoma is ongoing at specialized cancer centers around the world. Clinical trials test innovative therapies that may improve outcomes for patients, particularly those with advanced disease or tumors that have spread beyond the eye. While these experimental treatments show promise, it’s important to understand that they are still being studied to determine their safety and effectiveness.

Understanding Clinical Trial Phases

Clinical trials proceed through different phases, each with specific goals. Phase I trials test whether a new treatment is safe and identify the appropriate dose. These studies involve small numbers of participants and focus primarily on safety. Phase II trials examine whether the treatment actually works against the cancer and continues to monitor safety in a larger group of patients. Phase III trials compare the new treatment to current standard treatments to see if it offers improvements in outcomes or fewer side effects.^[9]

Genetic Testing and Targeted Therapies

Recent advances have revealed important genetic information about choroidal melanomas. Researchers have found that these tumors often have specific genetic changes that may make them vulnerable to targeted treatments. Many centers now routinely perform genetic tumor analysis on biopsy samples to identify these changes and understand each patient’s individual risk of the cancer spreading.^[2]

This genetic information is helping researchers develop new drugs that target specific molecular pathways involved in melanoma growth. While skin melanoma and eye melanoma are both melanomas, they have different genetic profiles and respond to different treatments. Clinical trials are testing drugs specifically designed for the genetic changes found in uveal melanomas.

Immunotherapy Approaches

The immune system normally helps protect the body against cancer, but tumors can sometimes evade these defenses. Immunotherapy treatments aim to boost or restore the immune system’s ability to recognize and attack cancer cells. Several types of immunotherapy are being studied in clinical trials for patients with choroidal melanoma that has spread to other parts of the body.

These treatments work through different mechanisms. Some block proteins that prevent immune cells from attacking the tumor. Others help activate specific immune cells to target melanoma more effectively. While immunotherapy has shown remarkable success in treating skin melanoma, choroidal melanoma has generally been less responsive to these treatments. However, research continues to identify which patients might benefit and how to improve the effectiveness of immune-based therapies for this disease.^[12]

Clinical Trial Locations and Eligibility

Clinical trials for choroidal melanoma are conducted at specialized cancer centers in the United States, Europe, and other regions around the world. Patients interested in participating in a trial need to meet specific eligibility criteria, which vary depending on the study. Factors that may affect eligibility include the size and location of the tumor, whether the cancer has spread, previous treatments received, and overall health status.^[9]

Participation in clinical trials can provide access to cutting-edge treatments that are not yet widely available. However, experimental therapies may have unknown side effects, and there is no guarantee that a new treatment will work better than standard options. Patients should discuss the potential benefits and risks of clinical trial participation with their eye cancer specialist to determine if this approach is appropriate for their situation.

Most Common Treatment Methods

• Radiation Therapy
  • Plaque brachytherapy using radioactive materials such as iodine-125, ruthenium-106, or palladium-103 placed directly on the eye for several days
  • Proton beam therapy delivering focused radiation from outside the body in multiple treatment sessions
  • Gamma knife and stereotactic radiotherapy for precise targeting of tumors in difficult locations
• Surgical Treatments
  • Enucleation (complete eye removal) for large tumors or when the eye has no remaining vision
  • Local tumor resection to surgically remove the melanoma while preserving the eye in select cases
  • Fitting of ocular prosthesis after eye removal for cosmetic restoration
• Laser Therapy
  • Laser photocoagulation to destroy small tumors using focused light energy
  • Used as standalone treatment for very small melanomas or as additional therapy with radiation
• Monitoring and Supportive Care
  • Observation with regular imaging for very small tumors that may not require immediate treatment
  • Injections of medications like Avastin to manage fluid buildup and preserve vision
  • Treatment of radiation side effects including cataracts and retinal damage