In patients with small tumors that have not spread, intraocular melanoma can be cured and vision can usually be saved. Certain factors affect the chance of recovery and treatment options. The prognosis depends on the following:
- Patient's age and general health
- Type of melanoma cells (how they look under a microscope)
- Size of the tumor
- Which part of the eye the tumor is in (the iris, ciliary body, or choroid)
- Whether the tumor has spread within the eye or to other places in the body
- Whether the tumor has recurred after treatment.
Different types of treatments are available for patients with intraocular melanoma. Some treatments are standard, and some are being tested in clinical trials. There are five types of standard treatments in use, described as follows.
Surgery is the most common treatment for intraocular melanoma. The following types of surgery may be used:
- Local Tumor Resection: Surgery to remove the tumor and a small amount of healthy tissue around it.
- Enucleation: Surgery to remove the eye and part of the optic nerve. This is done if the tumor is large and vision cannot be saved. The patient may be fitted for an artificial eye after enucleation.
- Exenteration: Surgery to remove the eye and eyelid, and muscles, nerves, and fat in the eye socket. The patient may be fitted for an artificial eye or facial prosthesis after exenteration.
Watchful waiting is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change. A series of pictures is taken over time to keep track of changes in the size of the tumor and how fast it is growing.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:
- External radiation therapy uses a machine outside the body to send radiation toward the cancer
- Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer
The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Photocoagulation is a procedure that uses laser light to destroy blood vessels that supply nutrients to the tumor, causing the tumor cells to die. Photocoagulation may be used to treat small tumors. This is also called light coagulation.
Thermotherapy is the use of heat to destroy cancer cells. Thermotherapy may be given using:
- A laser beam aimed through the dilated pupil or onto the outside of the eyeball
- Infrared radiation (light that cannot be seen but can be felt as heat)
Retinoblastoma may occur at any age, but usually occurs in children younger than 5 years of age. The tumor may be in one eye or in both eyes; retinoblastoma rarely spreads from the eye to nearby tissue or other parts of the body. Retinoblastoma is usually found in only one eye and can usually be cured.
The chance of recovery (prognosis) and treatment options depend on the following:
- The stage of the cancer
- How likely it is that vision can be saved in one or both eyes
- The size and number of tumors
- Whether the patient has glaucoma
- Whether trilateral retinoblastoma occurs
If the cancer is in one eye and the tumor is large, treatment is usually enucleation. Chemotherapy may be given to shrink the tumor before surgery. If the cancer is in one eye and it is expected that vision can be saved, treatment may include the following:
- Radiation therapy
- Chemotherapy (chemoreduction)
- A clinical trial of chemotherapy using more than one anticancer drug
If the cancer is in both eyes, treatment may include the following:
- Enucleation of the eye with the most cancer, and radiation therapy to the other eye
- Radiation therapy to both eyes or chemotherapy (chemoreduction) followed by local treatment. This may be done if there is a chance to save vision in both eyes.
- Radiation therapy to both eyes followed by chemotherapy.
- Surgery only, when vision cannot be saved.
- A clinical trial, including new combinations of chemotherapy and other treatments, gene therapy, ophthalmic arterial infusion therapy, or high-dose chemotherapy with stem cell transplant
There is no standard treatment for extraocular retinoblastoma. Radiation therapy and chemotherapy have been used. If treatment is enucleation, chemotherapy to shrink the tumor may be given before surgery. Treatment may be a clinical trial of high-dose chemotherapy with stem cell transplant.
If the cancer is small and in the eye only, treatment is usually local therapy (enucleation, radiation therapy, cryotherapy, photocoagulation, or thermotherapy).
If the cancer comes back outside of the eye, treatment will depend on many things and may be within a clinical trial.