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Intraocular Choroidal Melanoma

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Intraocular Choroidal Melanoma

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Approximately 1,500 new cases of choroidal melanoma are diagnosed in the U.S. each year. Melanocytes, the pigment-making cells of your skin, can create melanomas and non-cancerous moles on the skin, including the eyelid.

In the eye, these cells begin growing in the choroid, a heavily pigmented layer underneath the retina, which is full of blood vessels. They also can grow in the iris, a circular structure in the eye. The iris controls the diameter and size of your pupil and gives your eye its color.

Why Choose Sylvester Comprehensive Cancer Center?

Sylvester is an NCI-designated cancer center. The National Cancer Institute has reaffirmed us as South Florida’s only NCI-designated cancer center. We have been recognized for our scientific leadership, our commitment to training the next generation of cancer researchers and providers, as well as our engagement with the communities that we serve. For patients, this designation translates into greater access to leading-edge treatment options, including clinical trials that prioritize your specific cancer.

Ultra-high frequency OCT (optical coherence tomography). This optical ultrasound diagnoses melanomas and conjunctival tumors without biopsy or radiation exposure. OCT allows your doctor to monitor suspicious moles in your eye and to treat them if they change.

Advanced diagnostic technology. With the region’s most advanced imaging technologies, experts at Sylvester and Bascom Palmer Eye Institute provide fast, accurate diagnosis to create a precise, personalized treatment plan.

Localized plaque radiation therapy to treat the melanoma while protecting the rest of the eye from radiation. Approximately 95 percent of patients with ocular melanoma receive this form of targeted radiation.

Sylvester is one of only six designated Cancer Centers of Excellence in Florida. And as the only one located in South Florida, you will have the comfort of knowing you are in the best possible place to treat your cancer.

Bascom Palmer Eye Institute - ranked #1 by U.S. News & World Report. Bascom Palmer is the top-rated facility in the country for the treatment of diseases and disorders of the eye, according to U.S. News & World Report. When you choose us for your eye care, you will receive the best care in the nation in a compassionate setting.

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Treatments


Sylvester ocular specialists are trained to distinguish between intraocular melanoma and conjunctival melanoma. The two cancers are treated differently. Each new patient’s case is reviewed at a multidisciplinary team conference of eye cancer experts. Your team of specialists reviews all of your test results to recommend a personalized treatment plan. Your plan may include a combination of the following treatments:

  • Localized Plaque Radiation Therapy

    About 95 percent of patients with ocular melanoma of both types receive this form of brachytherapy. Radioactive seeds are attached to a "plaque"— a type of tiny disk. It's placed on the wall of the eye. The side with the seeds is placed against the eyeball. It delivers radiation to the eye, while the other side of the plaque helps protect nearby tissues from radiation damage. During the procedure to implant the plaque, the ophthalmic oncologist can biopsy the lesion to help determine other treatments and follow-up care.

  • Surgery

    • Enucleation: This involves removing the eye and part of the optic nerve. The operation is offered when vision cannot be saved, the tumor has spread to the optic nerve, is large in size, or causes high pressure inside the eye. After surgery, the patient is usually fitted for an artificial eye to match the size and color of their other eye.

    • Sentinel node biopsy: If cancer is suspected of spreading, your specialist may do a sentinel node biopsy, a surgical procedure to sample lymph nodes for cancer cells. The sentinel nodes are the first few lymph nodes into which a tumor drains. Your surgeon will inject a tracer material that lights up the lymph node or nodes closest to the tumor. These are removed and analyzed in a laboratory. If the sentinel nodes are free of cancer, it likely has not spread and removing additional lymph nodes is unnecessary.

    • Photocoagulation (laser thermal therapy): Laser light is used to destroy the tumor and its blood supply. It is only used to treat small tumors.

  • Localized Chemotherapy

    When ocular tumors metastasize, they often go to the liver. Sylvester specialists are proficient in a localized chemotherapy called hepatic perfusion to treat these types of ocular cancers.

  • Targeted Therapy and Clinical Trials

    Some melanomas are more likely to metastasize or spread to other organs. Researchers have found that about 70 percent have microscopic metastases. For this reason, they are investigating certain drugs that could put those cells to sleep. One class, called H-DAC inhibitors is being tested in several trials.

  • Active Surveillance

    For every patient with a clear diagnosis of intraocular melanoma, 10 fall into a gray area. Part of our monitoring involves using OCT (optical coherence tomography) to watch those areas. Its high resolution can determine effects on the surrounding area, which indicates melanoma, rather than a freckle. It can also monitor the presence of subretinal fluid, which can be a risk factor for melanoma.

Tests


Besides a medical history and physical exam, the following tests and procedures are used:

  • Dilated Eye Exam

    A dilated exam of your eye allows your doctor to look through the eye’s lens and pupil to your retina and optic nerve. Pictures may be taken over time to track changes in the size of your tumor. There are several types of eye exams:

    • Ophthalmoscopy: A small magnifying lens and a light are used to examine the inside of the back of your eye to check the retina and optic nerve.

    • Slit-lamp biomicroscopy: Biomicroscopy checks the retina, optic nerve and other parts of the eye with a strong beam of light and a microscope.

    • Gonioscopy: This exam looks at the front part of your eye between the cornea and iris. It uses a special instrument to see if the area where fluid drains out of the eye is blocked.

    • Ultrasound: After eye drops to numb your eye, a small probe is gently placed on the surface of the eye to send and receive sound waves. This makes a picture of the inside of the eye and the distance from the cornea to the retina.

    • Ocular coherence tomography (OCT): This imaging test uses light waves to take cross-section pictures of the retina, and sometimes the vascular layer of the eye (choroid), to see if there is swelling or fluid beneath the retina. This test, along with fluorescein angiography and a clinical exam, helps distinguish small melanomas from an indeterminate nevus (mole) by looking at the blood flow and cell packing.

  • Transillumination

    The ophthalmologist places a light on either the upper or lower lid to examine the iris, cornea, lens and ciliary body of the eye.

  • Fluorescein Angiography

    This procedure examines blood vessels and blood flow inside the eye. An orange fluorescent dye helps us find any areas that are blocked or leaking.

  • Indocyanine Green Angiography

    This similar procedure uses a different injected dye to look at blood vessels in the vascular layer of the eye to find blocked or leaking areas.

  • Biopsy and Genomic Tumor Profiling

    Sometimes a biopsy of tissue is done during the treatment process to help guide therapy. The following test may be performed on the sample of tissue:

    • Genomic tumor profiling: We look at a 15-gene profile with a computer. The computer shows us the pattern of genes and assigns as class 1, (low risk of metastasis); class 2, (high risk); and class 1-B, (intermediate risk). Through genomic profiling, your ophthalmic oncologist determines how often to screen you for recurrence or spread of the disease. It also helps your doctor select a therapy for your cancer.

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Note: Health plans that are currently contracted with UHealth are listed below. However, please check with your insurance provider to verify that UHealth is part of your provider network.

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