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.