Diagnosis is usually made using specialised eye examinations and imaging tests.
Your specialist may perform:
Dilated retinal examination
Ocular ultrasound scan
Optical coherence tomography (OCT)
Fundus photography
Fundus autofluorescence imaging
Additional imaging where appropriate
In many cases, a biopsy is not required to establish the diagnosis.
Several factors help determine treatment recommendations and long-term prognosis.
These include:
Tumour size
Tumour thickness
Tumour location
Distance from the optic nerve and macula
Growth characteristics
Genetic and molecular features where available
Your specialist will explain how these factors apply to your individual case.
Treatment depends on the size, location and characteristics of the melanoma.
Options may include:
Plaque brachytherapy (radiotherapy)
Proton beam radiotherapy
Local tumour resection in selected cases
Enucleation (removal of the eye) for some large tumours
Observation of selected indeterminate lesions
Systemic treatment in advanced disease
The aim is to treat the tumour effectively while preserving vision whenever possible.
For many patients, treatment involves plaque brachytherapy.
A small radioactive plaque is temporarily attached to the outside of the eye directly over the tumour.
The plaque delivers targeted radiation to the melanoma whilst minimising exposure to surrounding tissues.
Benefits of plaque brachytherapy include:
Eye preservation in most patients
Effective local tumour control
Short hospital stay
Established long-term outcomes
Proton beam therapy is a highly precise radiotherapy, and some patients may be suitable for it.
This treatment delivers highly focused radiation to the tumour while reducing exposure to surrounding structures.
Proton therapy may be particularly valuable for:
Tumours near the optic nerve
Tumours near the macula
Selected larger lesions
Your ocular oncology team will advise whether proton therapy is appropriate.
Many patients with choroidal melanoma are successfully treated and maintain useful vision following treatment.
However:
No treatment can guarantee cure.
Visual outcomes vary between individuals.
Some patients may experience tumour recurrence.
Some patients may develop metastatic disease despite treatment.
Long-term outcomes depend on tumour-specific factors.
Your consultant will discuss the likely benefits, risks and uncertainties relating to your individual diagnosis.
All treatments carry potential risks. Potential complications may include:
Reduced vision
Cataract
Radiation retinopathy
Radiation optic neuropathy
Retinal detachment
Dry eye symptoms
Requirement for further treatment
Loss of the eye in selected cases
Local recurrence
Metastatic disease
Specific risks vary according to the treatment performed and will be discussed during consultation.
Following treatment, regular monitoring is essential.
Follow-up may include:
Eye examinations
Ocular ultrasound scans
Retinal imaging
Visual assessment
Liver surveillance
Cross-sectional imaging where appropriate
The frequency of monitoring depends on the features of the tumour and your individual risk profile.
Although lifestyle changes cannot eliminate the risk of recurrence, maintaining good general health is important.
We recommend:
Attending all follow-up appointments
Reporting new symptoms promptly
Maintaining a healthy weight
Not smoking
Participating in recommended surveillance programmes
Many patients achieve long-term local tumour control following treatment. Your individual outlook depends on the size and characteristics of the tumour.
Vision may be affected by both the tumour and its treatment. The impact varies according to tumour size and location.
Many choroidal melanomas can be treated without removal of the eye.
However, enucleation (surgical removal of the eye) may occasionally be recommended if:
The tumour is very large
The eye is painful
Useful vision cannot be preserved
Alternative treatments are unlikely to provide adequate tumour control
If enucleation is required, your surgical team will discuss prosthetic eye rehabilitation and support services.
Choroidal melanoma can spread outside the eye in some patients.
The liver is the most common site of spread, although other organs can also be affected.
The risk varies according to:
Tumour size
Genetic features
Histological characteristics
Stage at diagnosis
Your consultant may recommend ongoing surveillance to monitor for signs of metastatic disease.
Most treated tumours remain controlled.
However, recurrence can occur and regular follow-up helps detect any changes at an early stage.
Your consultant will explain your individual risk and surveillance schedule.
Many patients require long-term surveillance following treatment. The exact duration and frequency depend on the characteristics of the melanoma.
Our ophthalmic oncology specialists require a referral letter or medical report prior to booking an initial consultation.
Please send these documents to our referrals team, who will liaise with the consultant to ensure you are seen by the most appropriate specialist.
This includes an initial consultation and a visual acuity assessment.
If further outpatient tests and investigations are required, they will be charged at an additional rate. The most commonly required test is an OCT scan. Your consultant will discuss this with you at your consultation.
The cost of onward treatment will be provided after initial consultation, based on your personalised treatment plan.
Lines are open Monday to Friday, 8am to 6pm excluding bank holidays for general enquiries or to book an appointment.
Send us your enquiry and we will get back to you as soon as possible, usually within one working day