Comparison Of Cutaneous And Ocular Melanomas
As well as melanocytes situated in the skin, melanocytes that reside within the uvea and conjunctiva originate from neural crest. Despite shared cellular origin cutaneous and ocular melanomas show noticeable differences regarding incidence rate, pattern of metastasizing, treatment modality and underlying genetic mutations. Role of solar UV radiation which is well supported as risk factor for cutaneous melanoma is still uncertain for ocular melanoma. Comparison of cutaneous and ocular melanoma is presented in .
How Is Intraocular Melanoma Diagnosed
An eye exam with pupil dilation is usually used to diagnose intraocular melanoma. Using medicated drops, doctors are able to look inside the eye, inspect for a tumor and take photos of eye structures.
A magnifying lens and light, a microscope or other special instruments may be used to examine the back, inside and front of the eye.
Additionally, they may assess the patients general health and well-being. Family history may also help doctors determine whether cancer is likely.
Other eye exams may also detect and take images of a tumor, including:
Ocular Melanoma Survival Rate
A number of clinical, pathological, and hereditary prognostic aspects have been recognized as being associated with higher risk of establishing metastatic ocular melanoma . Higher risk of metastasis is related to big tumor size, ciliary body involvement, orange pigment overlying the tumor and older patient age. Pathological findings such as epithelioid morphology, is likewise related to higher risk of metastasis. Unlike melanomas of the skin, a tumor staging system is not extensively used by ocular oncologists. OM rarely spreads out through the lymph system, instead it is most likely to spread out hemotogenously, or through the blood.
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What Is The Survival Rate For Ocular Melanoma
The overall 5-year survival rate for all eye-related melanoma is 82 percent.
When melanoma does not spread outside the eye, the 5-year relative survival rate increases to about 85 percent.
Unfortunately, the 5-year survival rate for those when the disease has spread to surrounding tissues or organs or the regional lymph nodes decreases to 71 percent.
Early detection of any cancerous or tumors of the eye is essential to achieving the best results.
If you notice any changes to your eyes or vision, schedule an appointment with an eye doctor near you.
Incidence Of Uveal Melanoma
Analysis of the Surveillance, Epidemiology, and End Results program database of the United States National Cancer Institute over a 36-year period between 1973 and 2008, including 4070 patients with primary uveal melanoma, revealed an overall mean age-adjusted incidence of uveal melanoma at 5.1 cases per million per year. Similarly, analysis of data from the European Cancer Registry-based study on survival and care of cancer patients in Europe, including 6673 patients with uveal melanoma diagnosed from 1983 to 1994, revealed standardized incidence rates of 1.38.6 cases per million per year. In Europe, the incidence of uveal melanoma followed a north-to-south decreasing gradient from a minimum of 2 per million per year in Spain and southern Italy to a maximum of 8 per million per year in Norway and Denmark. This north-to-south decreasing gradient is related to the protective effect of ocular pigmentation in the southern populations with respect to higher exposure to ultraviolet light at lower latitudes. The incidence of uveal melanoma is low in Africa and Asia, with an incidence rate of 0.20.3 cases per million per year. Across continents, there has been no significant change in the overall incidence of uveal melanoma over the years., , , Based on region of origin, the number of uveal melanoma cases per year has been estimated per population at 316 for Africans, 857 for Asians, 1154 for Hispanics, and 4351 for White non-Hispanics.
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Purpose Of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of intraocular melanoma. It is intended as a resource to inform and assist clinicians in the care of their patients. It does not provide formal guidelines or recommendations for making health care decisions.
Patient And Histopathological Characteristics
Both clinical information, such as age at enucleation, gender, affected eye, and ocular treatment prior to enucleation, and data on histopathological characteristics were collected from patient charts. Histopathological characteristics were determined through routine conventional analysis by ophthalmic pathologists. These included tumor location, involvement of the ciliary body, tumor thickness, largest basal diameter, and cell type. Tumors were staged in accordance with the 8th edition of the AJCC Cancer Staging Manual, using the TNM model for anatomical staging .
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American Joint Committee On Cancer Classification
The AJCC is an attempt to unify the clinical prognostic factors into a single classification system. In this classification, iris melanoma is graded according to tumor extent, associated secondary glaucoma, and EOE. Posterior uveal melanoma is graded according to tumor basal diameter and thickness, ciliary body involvement, and extraocular extension. The patients with advanced AJCC tumor staging exhibit poor prognosis.
In a study of 452 patients with iris melanoma based on AJCC classification, the 10-year metastatic rate was 2% for stage I tumors, 6% for stage II, and 41% for stage III. In a study of 7731 patients with posterior uveal melanoma based on T category of AJCC classification, the 10-year metastatic rate was 15% for T1 tumors, 25% for T2, and 49% for T3, and 63% for T4. The risk for metastasis and death increased two-fold with each increasing tumor category. Based on AJCC staging for posterior uveal melanoma, 10-year metastatic rate was 12% for stage I tumors, 29% for stage II, and 61% for stage III. The risk for metastasis and death increased three-fold with each increasing melanoma staging.
Symptoms Of Intraocular Melanoma
Intraocular melanoma may have no symptoms. In this case, a tumor may be found during a regular eye check-up with an ophthalmologist . In other instances, intraocular melanoma may affect vision. Keep in mind that other conditions may cause these symptoms, too, so a thorough examination with an eye care specialist is important to narrow down the root cause of any vision problems.
Intraocular melanoma may cause:
- Dark spot on the iris, especially for iris melanoma
- Blurry vision or trouble seeing
- Flashes of light or spots in field of vision
- Change in pupil size or shape
- Shifts in position or movement of the eye within the socket
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Epidemiology Of Ocular Melanoma
Although it is the second most common type of melanoma, ocular melanoma is still rare, and accounts for 3.7% of all melanoma cases . In the US incidence of ocular melanoma is 6 per million, compared with 153.5 for cutaneous melanoma . It is more common among men, with incidence of 6.8 per million, compared with 5.3 per million in women . In Australia ocular melanoma shows higher rates, with incidence of 8 per million in men, and 6.1 per million in women .
Incidences of uveal and conjunctival melanomas in the US are 4.9 and 0.4 per million, respectively . In Europe uveal melanoma incidence shows the north-to-south gradient, decreasing from over 8 per million in northern to less than 2 per million in southern countries . In the US ocular melanoma rates were found to be lower in southern states than in northern states mainly because of lower rates of choroidal melanoma . In contrast, iris and ciliary body melanoma were more common in southern and costal states than in northern and non-costal states, which is also characteristic of cutaneous melanoma .
Ocular melanoma rates are 8-10 times higher among whites compared with blacks, but although obvious this difference is less pronounced compared to cutaneous melanoma which shows 16 times higher rates among whites . In contrast to other ocular melanomas conjunctival melanoma rates are 2.6 times higher in whites than in blacks, which is similar with that of mucosal melanomas .
Extraocular Extension And Metastatic Intraocular Melanoma
Extrascleral extension confers a poor prognosis. For patients with gross tumor involvement of the orbit, treatment requires orbital exenteration. However, there is no evidence that such radical surgery will prolong life. Most patients with localized or encapsulated extraocular extension are not exenterated. This subject is controversial.
No effective method of systemic treatment has been identified for patients with metastatic ocular melanoma. Clinical trials are an option for these patients.
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Diagnosing Melanoma Of The Eye
If your GP or optician suspects you have a serious problem with your eyes, they’ll refer you to a specialist eye doctor called an ophthalmologist for an assessment.
If they suspect you have melanoma of the eye, they’ll refer you to a specialist centre for eye cancer.
There are 4 centres in the UK, located in London, Sheffield, Liverpool and Glasgow.
It’s likely you’ll have a number of different tests at the centre, including:
- an eye examination to look at the structures of your eyes in more detail and check for abnormalities
- an ultrasound scan of your eye a small probe placed over your closed eye uses high-frequency sound waves to create an image of the inside of your eye this allows your doctor to find out more about the position of the tumour and its size
- a fluorescein angiogram where photographs of the suspected cancer are taken using a special camera after dye has been injected into your bloodstream to highlight the tumour
Occasionally, a thin needle may be used to remove a small sample of cells from the tumour .
The genetic information in these cells is analysed to give an indication of the chances of the cancer spreading or coming back.
Survival Rates And Statistics
According to a 2016 study in The British Journal of Ophthalmology:
- Intraocular melanoma represents about 3 percent to 5 percent of all melanomas in the United States.
- About 85 percent to 90 percent of intraocular melanomas begin in the choroid.
- Up to 50 percent of patients experience metastasis, meaning their cancer spreads to other parts of the body.
About 73 percent of patients are diagnosed at an early stage, according to ASCO. In comparison, 2 percent to 3 percent of people are diagnosed at a more advanced stage with spread to distant parts of the body.
The ASCO outlines five-year survival rates for intraocular melanoma. This statistic means the percentage of individuals surviving five years after their cancer diagnosis.
- For those whose eye cancers were diagnosed at an early stage, meaning without spread, the five-year survival rate is 85 percent.
- For eye cancers that have spread into surrounding tissue or organs and/or nearby lymph nodes, the rate is 71 percent.
- For eye cancers that have spread to distant parts of the body at the time of diagnosis, the rate is 13 percent.
Survival rates also depend on the type of melanoma.
- For iris melanoma, which doesnt typically spread, the five-year survival rate is more than 95 percent.
- For choroidal melanoma, the five-year survival rates vary by the size.
- Small choroidal melanoma: 84 percent
- Medium choroidal melanoma: 68 percent
- Large choroidal melanoma: 47 percent
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Eye Cancer Survival Rates
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as he or she is familiar with your situation.
The Collaborative Ocular Melanoma Study
The Collaborative Ocular Melanoma Study is a prospective multicenter trial that was funded and organized by the National Eye Institute in 1985 to evaluate the role of different interventions for patients with uveal melanoma. The first patient was enrolled in 1987 and accrual was completed in 1998. To date, the COMS is the largest study performed in ocular oncology. There were three major prospective multicenter COMS trials . The results of the COMS confirmed numerous previous publications regarding management of choroidal melanoma.
Large-size tumor trial
The Zimmerman-McLean-Foster Hypothesis inspired the use of additional treatments with enucleation, such as pre- or post-enucleation radiation, particularly in large choroidal melanomas. This trial sought to evaluate if pre-enucleation radiotherapy offered a survival benefit compared to enucleation alone.
Large choroidal melanomas were defined as 2.0 mm or more in apical height and greater than 16.0 mm in longest basal diameter, or more than 10.0 mm apical height regardless of basal diameter, or greater than 8.0 mm apical height regardless of basal diameter if less than 2.0 mm to the optic disc.
The 10-year survival rates were 40% in the enucleation alone group and 45% in the pretreatment radiation group. The authors concluded that no survival differences were observed.
Following these trials, pre-enucleation radiotherapy was abandoned.
Medium-size tumor trial
Small-size tumor trial
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Treatment Options For Medium And Large Choroidal Melanomas
Results from the second COMS clinical trial, which compared 125-I plaque brachytherapy to enucleation in patients with medium-sized choroidal tumors, revealed no significant difference in cumulative all-cause mortality between the two study arms at 12 years of follow-up . In addition, the 12-year rates of death with histopathologically confirmed melanoma metastasis did not differ significantly between the 2 study arm. Among the patients treated with 125-I brachytherapy, 85% retained their eye for 5 years or more, and 37% had visual acuity better than 20/200 in the irradiated eye 5 years after treatment.
Survival For All Stages And Types Of Eye Cancer
There are no UK-wide statistics available for different types and stages of eye cancer. The type of cancer refers to the type of cell that it starts in. The stage of eye cancer depends on how big the cancer is and if it has spread.
Eye cancer is rare and so the figures available are for all eye cancers in England.
Generally for people with eye cancer in England:
- 95 out of every 100 will survive their cancer for 1 year or more after they are diagnosed
- 70 out of every 100 will survive their cancer for 5 years or more after diagnosis
- 60 out of every 100 will survive their cancer for 10 years or more after they are diagnosed
These statistics are for people diagnosed with eye cancer in England between 2009 and 2013.
Net survival and the probability of cancer death from rare cancers.P Muller and othersCancer Research UK Cancer Survival Group, London School of Hygiene and Tropical Medicine
These statistics are for net survival. Net survival estimates the number of people who survive their cancer rather than calculating the number of people diagnosed with cancer who are still alive. In other words, it is the survival of cancer patients after taking into account that some people would have died from other causes if they had not had cancer.
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Management Of Uveal Melanoma
Management of uveal melanoma varies from observation to orbital exenteration depending on the particular case, and mostly depending on the site, size of tumor and local extension.
Most patients with posterior uveal melanoma are currently treated with plaque radiation therapy or enucleation. Other available options include particle beam radiotherapy, transpupillary thermotherapy, laser photocoagulation, gamma knife stereotactic radiosurgery and local surgical resection. Iris melanoma is in most cases treated by surgical resection. Larger non-resectable tumors can be treated by plaque radiotherapy or enucleation . Method of treatment of iris melanoma did not show an impact on the occurrence of metastases . Small and medium-sized choroidal tumors are mostly treated by radiation therapy, while large tumors, especially if locally advanced, are still mostly treated by enucleation or orbital exenteration. COMS trial for medium-sized tumors did not show a difference in mortality rates between patients managed by brachytherapy compared to those managed by enucleation . For large-sized tumors preceded external radiation did not show advantage compared to enucleation alone .
Permission To Use This Summary
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The preferred citation for this PDQ summary is:
PDQ® Adult Treatment Editorial Board. PDQ Intraocular Melanoma Treatment. Bethesda, MD: National Cancer Institute. Updated < MM/DD/YYYY> . Available at: . Accessed < MM/DD/YYYY> .
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Symptoms Of Eye Cancer
Eye cancer does not always cause obvious symptoms and may only be picked up during a routine eye test.
Symptoms of eye cancer can include:
- shadows, flashes of light, or wiggly lines in your vision
- blurred vision
- partial or total loss of vision
- bulging of 1 eye
- a lump on your eyelid or in your eye that’s increasing in size
- pain in or around your eye, although this is rare
These symptoms can also be caused by more minor eye conditions, so they’re not necessarily a sign of cancer.
But it’s important to get the symptoms checked by a doctor as soon as possible.