Choroidal melanoma is a rare but serious cancer that develops in the eye, specifically in a layer of blood vessels beneath the retina. While it affects only a small number of people each year, timely medical evaluation and treatment can help preserve vision and control the disease. Understanding the treatment approaches—from proven therapies to those being tested in clinical trials—offers patients and their families valuable information for making informed healthcare decisions.

Hope and Strategy: What Treatment Aims to Achieve

When a person receives a diagnosis of choroidal melanoma, the main goals of treatment focus on controlling the tumor, preserving vision where possible, and preventing the cancer from spreading to other parts of the body. Because this cancer originates in the choroid—the vascular layer between the retina and the outer white wall of the eye—treatment must balance destroying cancer cells while protecting delicate eye structures responsible for sight. Not every patient can maintain perfect vision after treatment, but medical teams work to save as much visual function as possible and, most importantly, to preserve life.^[1][2]

The approach to treating choroidal melanoma depends on several factors. The size and location of the tumor within the eye play a critical role in deciding the best therapy. A small tumor near the iris may need different management compared to a large tumor pressing against the retina. Patient characteristics also matter—age, overall health, and the presence of other medical conditions influence treatment choices. Additionally, whether the cancer has begun spreading beyond the eye affects how aggressive the treatment needs to be.^[3][8]

Treatment options fall into two broad categories: standard therapies that have been tested and approved by medical societies, and experimental therapies currently being explored through clinical research. Standard treatments have a well-documented track record and are widely available. In contrast, clinical trials investigate newer methods that may one day improve outcomes or offer alternatives when standard approaches don’t work. Patients should understand that both types of treatment serve important roles in the fight against choroidal melanoma.^[11]

Proven Approaches: Standard Treatment for Choroidal Melanoma

The foundation of choroidal melanoma treatment rests on methods that physicians have used successfully for decades. The two most established approaches are radiation therapy and surgical removal of the eye, known as enucleation. Radiation therapy has become the preferred choice for many patients because it offers the chance to preserve the eye, even though vision may be affected.^[9][11]

Plaque radiotherapy, also called episcleral brachytherapy, represents one of the most common radiation treatments. During this procedure, a surgeon places a small disc containing radioactive material directly on the outside wall of the eyeball, positioned precisely over the tumor. The radioactive seeds—typically made of substances like iodine-125, ruthenium-106, or palladium-103—emit radiation that kills cancer cells over several days. After the calculated treatment period, usually four to seven days, the surgeon removes the plaque in a second brief procedure, typically under local anesthesia. This method delivers high doses of radiation directly to the tumor while limiting exposure to surrounding healthy tissue.^[6][9][11]

Another form of radiation therapy uses proton beam therapy, which directs a highly focused beam of protons at the tumor from outside the body. This external radiation technique offers precise targeting and works particularly well for tumors in challenging locations. Some medical centers also employ other external beam methods such as stereotactic radiotherapy or gamma knife radiation. All these radiation approaches aim to destroy tumor cells while attempting to spare normal eye tissue, though side effects remain a concern.^[9][11]

Side effects from radiation therapy can emerge months or even years after treatment. Radiation retinopathy is a condition where blood vessels in the retina become damaged by radiation, potentially causing vision loss. Patients may experience cataracts—clouding of the eye’s natural lens—which can develop over time. Other possible complications include dry eye symptoms, increased pressure within the eye leading to glaucoma, and in some cases, bleeding inside the eye. Some patients notice that their vision gradually worsens over the years following radiation, though the tumor itself may be successfully controlled.^[13][18]

Sometimes physicians combine radiation with another treatment called transpupillary thermotherapy, which uses a special laser to apply heat to the tumor. This combination may help control certain tumors more effectively. Injections of medications like bevacizumab (marketed as Avastin) into the eye can address fluid leakage and bleeding caused by radiation damage to blood vessels, helping to maintain better vision for some patients.^[11][18]

Enucleation—surgical removal of the entire eyeball—remains necessary when tumors grow too large for radiation therapy to be effective, when the eye has lost all useful vision, when the tumor causes severe pain, or when there is growth outside the eyeball. This surgery is also chosen when radiation might cause more harm than benefit. During the procedure, surgeons remove the eye while preserving the muscles and other structures in the eye socket. Patients later receive a prosthetic eye designed to match their natural eye, which can provide excellent cosmetic results and require minimal maintenance. While losing an eye represents a significant emotional and physical challenge, enucleation can be life-saving and allows patients to live cancer-free when the tumor is confined to the eye.^[9][11]

The duration of treatment varies considerably. Plaque radiation typically requires the patient to keep the radioactive disc in place for four to seven days, followed by months to years of monitoring for side effects. External beam radiation like proton therapy usually involves daily treatments over two to five days. Recovery from enucleation takes several weeks, with fitting for a prosthetic eye beginning about a month after surgery. Long-term follow-up continues for years, as doctors must watch for both local recurrence and the possibility of cancer spreading to distant organs, particularly the liver.^[6][9]

Most common treatment methods

• Radiation therapy
  • Plaque radiotherapy (episcleral brachytherapy) using iodine-125, ruthenium-106, or palladium-103 radioactive seeds placed directly on the eye wall over the tumor
  • Proton beam therapy directing focused radiation from outside the body
  • Stereotactic radiotherapy and gamma knife radiation for precise external targeting
  • Treatment period typically four to seven days for plaques, with long-term monitoring for complications
• Surgical procedures
  • Enucleation (complete removal of the eyeball) for large tumors or cases where vision cannot be preserved
  • Prosthetic eye fitting after enucleation for cosmetic restoration
  • Local tumor resection attempted in select cases
• Supportive treatments
  • Transpupillary thermotherapy (laser heat therapy) combined with radiation
  • Bevacizumab (Avastin) injections into the eye to manage radiation-related fluid leakage and preserve vision
  • Monitoring and treatment of radiation side effects including cataracts and glaucoma

New Frontiers: Treatment Being Explored in Clinical Trials

While standard treatments have proven effective at controlling tumors within the eye, choroidal melanoma presents a unique challenge: approximately half of all patients eventually develop metastasis, meaning the cancer spreads to other parts of the body, most commonly the liver. Once this occurs, survival rates drop dramatically. This harsh reality drives researchers to investigate new therapies that might prevent spread, treat metastatic disease more effectively, or improve outcomes for patients whose cancer has advanced.^[1][12]

Clinical trials represent organized research studies where patients volunteer to test new treatments under carefully controlled conditions. These trials typically progress through three phases. Phase I trials focus primarily on safety, determining what dose of a new drug or therapy can be given without causing unacceptable harm. Phase II trials examine whether the treatment actually works against the disease and begin to measure how well it performs. Phase III trials compare the new therapy against the current standard treatment to see if it offers advantages. Participation in clinical trials gives patients access to promising new approaches while contributing valuable information that may help future patients.^[8]

Research into choroidal melanoma treatment includes several different strategies. One approach focuses on understanding the genetic characteristics of individual tumors. Scientists have discovered that certain genetic changes within choroidal melanoma cells can predict whether the cancer is likely to spread. Tests that examine these genetic patterns may eventually help doctors identify which patients need more aggressive monitoring or preventive treatment. This personalized approach aims to match each patient with the therapy most likely to help them based on their tumor’s unique molecular signature.^[23]

Immunotherapy represents another promising research direction. These treatments work by helping the patient’s own immune system recognize and attack cancer cells. While immunotherapy has shown remarkable success against some types of melanoma that occur on the skin, choroidal melanoma has proven more resistant to these approaches. Researchers continue testing various immune-stimulating drugs, hoping to find combinations or modifications that work better for eye melanoma. Some trials investigate checkpoint inhibitors—medications that remove the brakes on immune cells—though results so far have been less impressive for uveal melanoma compared to skin melanoma.^[1]

Scientists are also exploring targeted molecular therapies. These drugs interfere with specific proteins or pathways that cancer cells use to grow and survive. By blocking these molecular signals, targeted therapies aim to stop tumor growth while causing less harm to normal cells than traditional chemotherapy. Researchers identify molecules involved in choroidal melanoma growth and development, then design drugs to disrupt those specific targets. This precision approach holds promise, though finding the right targets for this particular cancer remains challenging.^[1]

Clinical trials occur at specialized cancer centers around the world, including locations in the United States, Europe, and other regions where advanced eye cancer expertise exists. Eligibility for trials depends on many factors: the stage and characteristics of the disease, whether the patient has received prior treatment, overall health status, and sometimes specific genetic features of the tumor. Patients interested in clinical trials should discuss options with their ophthalmologist or oncologist, who can help determine whether any suitable studies are available.^[8]

It is essential to understand that experimental treatments carry uncertainties. New therapies being tested may ultimately prove ineffective or cause unexpected side effects. However, clinical trials also offer hope when standard treatments have limited success. The careful oversight and monitoring provided in clinical trials often means patients receive extremely attentive care. Additionally, trial participants contribute to medical knowledge that benefits future generations of patients facing the same disease.

Long-Term Care and Quality of Life

Living with choroidal melanoma extends far beyond the initial treatment period. Patients require lifelong monitoring because the cancer can recur in the eye or spread to distant organs years after the original diagnosis. Follow-up typically includes regular eye examinations, imaging tests like ultrasound to check the treated eye, and blood tests or liver imaging to watch for signs of metastasis. The liver represents the most common site of spread, so monitoring liver function through blood work and periodic scans becomes a critical part of long-term care.^[3][14]

Vision changes following treatment affect quality of life for many patients. Some experience gradual vision loss in the treated eye over months or years due to radiation effects. Others adapt to having useful vision in only one eye after enucleation or significant vision loss. Low vision rehabilitation services can help patients make the most of remaining vision through special devices, training in adaptive techniques, and modifications to living spaces. Occupational therapists specializing in vision loss teach strategies for daily activities, while orientation and mobility specialists can address challenges with depth perception and navigation.^[19][20]

The emotional and psychological impact of eye cancer deserves attention. Anxiety about cancer recurrence is common, particularly given the risk of metastatic disease. Depression can develop, especially when vision loss interferes with driving, reading, or other valued activities. Support groups specifically for ocular melanoma patients provide opportunities to connect with others facing similar challenges. Mental health professionals with expertise in cancer care or vision loss can offer counseling and coping strategies. Many patients find that addressing the emotional aspects of the disease improves their overall quality of life.^[19][21]

Lifestyle factors may also play a role in overall health after treatment. While no specific diet has been proven to fight choroidal melanoma, maintaining good nutrition supports the immune system and general well-being. A diet rich in fruits, vegetables, and whole grains provides essential nutrients and antioxidants. Regular physical activity, adapted as needed for vision changes, helps maintain strength and energy while potentially reducing anxiety and depression. Patients should discuss any dietary supplements with their doctors, as some may interact with treatments or monitoring tests.^[21]

Sun protection for the eyes remains a sensible precaution, though its role in choroidal melanoma is not fully understood. Some evidence suggests that ultraviolet light exposure may contribute to risk, so wearing sunglasses that block UV rays represents a reasonable preventive measure. This becomes particularly important for the remaining healthy eye in patients who have lost vision in or had enucleation of the affected eye.^[11]