Uveal melanoma that is contained within the eye can be treated in a number of ways. The treatment you receive will depend on a number of factors, including the size and position of your tumour.
Treatment will usually happen very quickly after diagnosis, but should, in any case, be started within 31 days of your treatment plan being agreed.
In the UK, we are lucky to have access to a huge variety of treatments across the four specialist eye centres, and your consultant will discuss them all with you and advise which are best for your personal circumstance.
Often patients will have a couple of options open to them, so it is very important to talk with your consultant to understand the pros and cons of the treatments offered.
OcuMel UK recommend patients utilise the resources available at the eye centres, for example; look at their website, read their leaflets, and, most importantly, talk to your nurse specialist, as he or she will be best placed to help you navigate this area.
If it is suitable, treating your tumour with radiation can spare your eye and possibly even your vision. There are two types of radiation – internal (placed inside your body) and external (coming from outside your body).
Plaque radiotherapy (local surface)
Plaque radiotherapy works by delivering a highly concentrated dose of radiation directly to the tumour via a radioactive implant, which causes very little damage to the surrounding area. If this treatment is appropriate for you, you will have two operations under general anaesthetic. The first operation is to attach the plaque to the wall of the eye and the second operation, four to seven days later, is to remove it
Proton beam radiotherapy (external beam)
Proton beam radiotherapy is used when plaque radiotherapy is not suitable and can offer an alternative to removal of the eye (enucleation) in some cases. The treatment itself takes place at Clatterbridge Centre for Oncology, which all the centres can refer to.
“After spotting the tumour purely by chance at an extraordinary eye examination (I’d had headaches for many weeks beforehand), I was immediately sent to the local hospital for an examination.
Within 5 days, I had been referred to the eye centre and received the diagnosis of Ciliary Body Melanoma. I was diagnosed on the Monday and on the operating table the next day so I literally had no time to think about the possible situations ahead. Embarking on Plaque Radiotherapy was certainly a whirlwind for me.
After having the plaque attached and being transferred to the recovery ward, I then underwent the recovery period. I didn’t feel well after the anaesthetic but was soon put at ease by the nurses. With regular checks of the eye and my blood pressure, and the insertion of drops, by Day 4 the plaque was ready to be removed.
I was much better recovering from the 2nd op and was discharged on the Friday. I was given drops to ward off infection for the next 10 days or so. The pain was minimal but I was plagued with fatigue for the next 12 months plus. That was the biggest thing for me, the tiredness ! All that said, if I had to go through it all again, I would do so in a flash.”
– Plaque Radiotherapy, November 2013. Aged 43
“After a routine optician appointment found ‘discolouration on the back of my eye’, I was referred to the eye centre and diagnosed with Choroidal Melanoma in December 2014.
Due to the tumour covering half my optic nerve, my only options for treatment were proton beam radiotherapy or enucleation. I was given the time to discuss the different options with the medical staff and decided that proton beam was the best option for me.
I was informed I will eventually lose all sight in my affected eye but decided that cosmetically I would like to keep my own eye. It was explained that the risk of metastatic spread was about the same as with either treatments.
I had the surgery to place the tantalum markers on to the back of my eye the next day and made it home that day. Afterwards, I was uncomfortable and I had a bruised, red eye for around two weeks but it wasn’t particularly painful. I managed to attend a wedding in Ireland on New Year’s Day, which I enjoyed, although I wished I’d had prescription sunglasses as sunshine and bright lights were unpleasant to be in.
I attended Clatterbridge Cancer Centre for a simulation and mask-making appointment in late January which I found quite overwhelming, but the staff understood this and helped greatly.
I returned on the 9th February for the treatment week. We stayed in a pleasant hotel and decided to make the best of things and be tourists for a week. The treatment was quick and painless. Getting your eye in the right position can take time and you have to sit still, but it wasn’t too bad.
The staff at Clatterbridge (including the taxi drivers who drove me to the hospital and back!) were brilliant; sympathetic, warm and full of local knowledge.
I had a biopsy on the last day of treatment and this was the worst part of it all. I elected to have a local anaesthetic but in hindsight I would have preferred a general anaesthetic.
I am happy with the treatment choice I made. I have to use eye drops for dry eye but 11 months on my sight is still pretty good and the most important thing is the tumour is shrinking.”
– Proton Beam Radiotherapy, February 2015, Aged 33
Stereotactic radiosurgery is a type of radiation treatment that uses gamma rays produced by a machine known as a “gamma knife”. Gamma rays are different from the x-rays used in a standard x-ray in that they have a much greater energy. Using a stereotactic system, these gamma rays can be accurately focused on the tumour in your eye.
The advantages of stereotactic radiosurgery are that it is performed under a local anaesthetic and treatment is completed in one day. Therefore access to this type of treatment may be quicker than for other types.
Amongst others sites of use, this treatment is highly useful for tumours wrapped around the optic nerve when placement of radiation plaque is difficult.
“I probably first became aware of a problem with my right eye in March of 2015. I was seeing flashing lights and a curtain appeared to have been drawn about half way across my vision. In May, I attended at hospital and was told I had a detached retina and was referred to the eye centre, where they carried out a more in-depth examination. I then found out I had Ocular Melanoma and it was the growth of this tumour which had caused the detached retina.
After taking advice I elected to have a procedure called Stereotactic Radiosurgery; a type of radiation therapy that uses narrow beams of radiation to attack the tumour. It is a one-off treatment and was relatively painless. The worst part was lying still for 25 minutes, with a specially constructed cage fitted to my head and bolted in to keep it from moving whilst the beams were delivered to the tumour.
I have a picture of me wearing it and I bore a striking resemblance to Mick Jagger in a film I once saw called ‘Ned Kelly’ about an Australian outlaw- but without the lips!
Soon after the treatment, I went home and that was it. I was told that it would be a minimum of 9 months before I knew whether it had been successful, but the procedure did have a very high success rate. I still have my eye and to all intents and purposes it still looks normal, but I have no vision in it because of the detached retina.
The hardest part for me is the deterioration of my peripheral vision as I can see nothing which approaches from my right side. I keep bumping into people, shopping trolleys and numerous other inanimate objects – luckily no cars yet though! I think I am adapting to it as time goes on.
Following my treatment, I am receiving scans on my liver every 6 months. This in itself can be stressful, but I am the sort of person who would rather know if there have been any developments in my condition as time goes on.”
– Stereotactic Radiosurgery, June 2015, Aged 60
Unfortunately, in some cases removal of the eye is the best option, for example when the tumour is too large for radiation and/or sight has been affected due to the size and position of the tumour. Occasionally the primary treatment is not successful so enucleation becomes necessary, or secondary complications make the eye painful. Some people prefer the idea of having their eye removed rather than waiting to see what happens with their radiation treatment.
If you are in the south of England and are happy to travel, you might want to consider asking your consultant about stereotactic radiosurgery in Sheffield or proton beam radiotherapy in Clatterbridge to see if either treatment would conserve your vision or eye. Sadly, sometimes it is just not possible, however, most patients adjust very well to the loss of their eye and with support from their eye centre, go on to live normal lives.
“I was diagnosed with Uveal Melanoma in August 2015. I elected to have my right eye removed as the tumour was affecting my sight and I was told it was in a difficult position. I had the enucleation in September 2015.
I was in hospital overnight and returned home with a pressure bandage on. It was a little uncomfortable but not particularly painful and any pain was easily managed with paracetamol. I had a shell fitted at the time of the operation.
The bandages were removed after 3 days and the district nurse came to clean my eye daily and put in ointment and drops for 2 weeks. I then took over doing this for the next 2 weeks.
I was very bruised and swollen but was recommended to put frozen peas on the bruising 4 times a day which worked wonders and soon brought the swelling down. After about 2 weeks this had gone down and the bruises had faded.
I was determined to drive as soon as possible and within 3 weeks adapted to driving with one eye. I had my temporary prosthetic eye fitted after 8 weeks and felt so much better – no more wearing sunglasses inside!! This took a bit of getting used to but I am getting more and more confident about it every day and have had some really positive comments about how good it looks. I am now waiting to go for my permanent eye fitting in a couple of weeks.
I have adapted well to all everyday tasks. I am driving and am playing tennis again and learning to live life to the full once more.”
– Enucleation, September 2015, Aged 60
Sometimes it is possible to operate on the eye to remove the tumour. This is called resection.
Trans-scleral local resection
The tumour is removed through an opening in the wall of the eye. It is often used when the tumour is large.
The tumour is removed through a hole in the retina. This can be useful when the tumour is located close to the optic nerve.
There are other treatments such as trans pupillary thermotherapy and photodynamic therapy. Your ocular oncologist will discuss your treatment plan in depth with you, and you may well have a combination of treatments. Don’t be afraid to ask your ocular oncologist any questions you have, or to tell them your fears. They are highly specialised practitioners and will be happy to help you understand what is happening and for you to be actively involved in planning your treatment.
“I noticed a heavy blurring of vision from November 2014. After a couple of local appointments, I was sent to the eye centre in February 2015, where I was diagnosed with a large Ciliary Body Melanoma in my right eye.
Due to the size of the tumour, viable treatment options were limited. I was told I could either have Enucleation, or Trans-scleral Resection surgery supplemented with Plaque Radiotherapy. The doctors felt the latter option had around a 70% chance of saving the eye, although it is a difficult procedure. I needed a little reassurance from both the doctors and additional internet research that my long term prognosis would not be altered whatever treatment path I opted for. After 24 hours of deliberation, I decided to go for the resection surgery in an attempt to retain the eye; feeling that I had nothing to lose.
The surgery does have risks associated with dropping the blood pressure to an abnormally low level throughout the 5-6 hour procedure, but I was very motivated to retain my eye and vision.
After the anaesthetic wore off I was confined to my own room in the eye ward due to the irradiated plaque. I did feel discomfort and a burning sensation, as a result of the plaque that was sutured into the eye. However, this was manageable with everyday painkillers throughout the period that the plaque was in place.
I remained in hospital for the week, with the plaque being removed through a secondary, shorter procedure four days later. I was able to return home and any residual pain gradually wore off in the week that followed.
Due to a bleed in the original resection procedure, my vision was very limited. In June 2015, the doctors felt I would be able to speed up the process of regaining sight with a Vitrectomy to remove the excess blood from the eye. Again, a relatively straight-forward operation, however, due to the very low eye pressure resulting from the original resection, the blood needed to be replaced with a silicone oil to stabilise the retina.
Vision was heavily distorted, but over time, I was able to make out hand movements and the eye slowly regained pressure with the aid of regular steroid drops. In October 2015, the doctors recommended removing the silicone oil and this was carried out in December 2015. Since then the eye pressure has now recovered to that of my good eye. My vision is slowly returning and, although it is still distorted, I am able to make out my children’s faces in the treated eye, which I feel is priceless. There is the hope of further improvement as the eye settles down.
I was determined to fight this cancer as best I could. That started with not wanting to lose the eye if I could help it, and to date it has been worthwhile. I would recommend this treatment pathway to others if they are offered it against the simple option of Enucleation and were motivated to save their eye. They would be in the best hands with the excellent team at the eye centre.”
– Trans-scleral Resection, March 2015, Aged 38