View All Pages

Eye Melanoma - Introduction

Approved by the Cancer.Net Editorial Board, 01/2023

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Eye Melanoma. Use the menu to see other pages. Think of that menu as a roadmap for this entire guide.

About the eye

The eye is the body's organ that collects light and sends messages to the brain. Those messages form a picture. The 3 main parts of the eye are:

  • Eyeball

  • Orbit (eye socket)

  • Adnexal (accessory) structures, such as the eyelid and tear gland

The eye is made up of several key structures: the cornea, conjunctiva, sclera, uvea, retina, and optic nerve. The cornea is the clear outer layer located at the front of the eye. The conjunctiva is the thin skin covering of the sclera, which is the white-colored outer wall of the eyeball. The uveal tract is the blood vessel-rich middle layer of the eye wall. The retina is a delicate and critical structure that is responsible for vision. Like the film in a camera, it lines the inner surface of the eyeball. The retina also sends information from the eye to the brain through the optic nerve. The uvea nourishes the eye. Both the retina and the uvea contain blood vessels.

The 3 main parts of the uvea are:

  • Iris: The iris is the colored circle at the front of the eye. It controls the amount of light entering the eye.

  • Ciliary body: The ciliary body is the muscular tissue that produces the watery fluid in the eye. The tissue helps the eye focus.

  • Choroid: The choroid is a layer of tissue underneath the retina in the back of the eye. It contains connective tissue and nourishes the inside of the eye.

See the Medical Illustrations section for detailed drawings of the eye.

About eye melanoma

Melanocytes are cells that produce melanin, which is a pigment that colors your skin, hair, and eyes. In the eye, melanocytes are located within the uveal tract. Eye melanoma begins when melanocytes change and grow out of control, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.

This guide is about primary eye melanoma, which means the tumor started in the eye. This is different from melanoma that spreads to the eye after it started somewhere else in the body, through a process called metastasis.

Eye melanoma is rare. However, it is the most common type of primary eye cancer in adults. After skin melanoma, eye melanoma is the second most common type of melanoma. It accounts for around 3% to 5% of all melanoma cases.

Specially trained ophthalmologists called ocular oncologists can diagnose and treat eye melanoma. They are medical doctors who specialize in the tumors and functions of the eye. Optometrists are another type of eye doctor. They prescribe eyeglasses and contact lenses. They are not medical doctors and are not trained to treat eye melanoma. However, optometrists perform eye exams and sometimes may discover an eye melanoma during a routine exam. Many patients may initially be diagnosed through an optometry exam and then referred to an ocular oncologist.

Eye melanoma is a different disease from melanoma of the skin and other types of melanoma. These include melanomas that develop in the gastrointestinal tract, vagina, the mucous membranes that line the mouth, and other locations around the body. Learn more about melanoma diagnosed in other parts of the body in these separate sections of this website:

Types of eye melanoma

  • Uveal melanoma. Eye melanoma is often called uveal melanoma. That is because around 95% of all eye melanoma starts in the uvea. In about 50% of people with uveal melanoma, the disease spreads to other parts of the body. Approximately 90% of the time, the melanoma spreads to the liver. It can also spread to other areas, including the lungs, skin, soft tissue, bone, and brain.

    There are 3 main subtypes of uveal melanoma:

    • Choroidal melanoma. More than 85% of uveal melanoma starts in the choroid. These tumors are often larger and are more likely to spread outside the eye compared with iris melanoma (see below).

    • Ciliary body melanoma. About 5% to 8% of uveal melanoma starts in the ciliary body. Because the ciliary body is located behind the iris, the disease can grow undetected for a longer time than choroidal melanoma or iris melanoma. As a result, the tumor is often larger when diagnosed. Ciliary body melanoma is more likely to spread outside the eye than iris and choroidal melanomas.

    • Iris melanoma. Iris melanoma is the least common type of uveal melanoma. The disease makes up only 3% to 5% of all uveal melanoma cases. The tumors are often small, grow slowly, and rarely spread outside the eye. They often appear as a growing dark spot on the iris. This makes them easier to see than the other forms of uveal melanoma.

  • Conjunctival melanoma. Conjunctival melanoma makes up less than 1% of all melanomas. A conjunctival melanoma often looks like a raised, pigmented or non-pigmented spot. The tumor appears most commonly in the bulbar conjunctiva, which is the part of the conjunctiva that covers the sclera.

    While conjunctival melanoma is much rarer than uveal melanoma, it may be more aggressive. The disease can spread to nearby areas, like the eyeball, orbit, and regional lymph nodes. The lymph nodes are small, bean-shaped organs located throughout the body that help fight infection. Conjunctival melanoma can also spread to distant areas, including most commonly the lungs. Other common areas of metastasis include the liver, brain, or bones. The disease tends to recur, or come back, after treatment. This type of eye melanoma is not the same as uveal melanoma. As a result, they are treated differently.

  • Orbital melanoma. Orbital melanoma affects the tissue around the eyeball. Extremely rare, it is the least common type of eye melanoma. As of 2018, which is the most recent data, an estimated 60 cases were reported worldwide. Orbital melanoma can be inactive for a long time before it becomes aggressive.

The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with eye melanoma and general survival rates. Use the menu to choose a different section to read in this guide.

Eye Melanoma - Statistics

Approved by the Cancer.Net Editorial Board, 02/2023

ON THIS PAGE: You will find information about the estimated number of people who will be diagnosed with eye melanoma each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors, and no 2 people with cancer are the same. Use the menu to see other pages.  

Every person is different, with different factors influencing their risk of being diagnosed with this cancer and the chance of recovery after a diagnosis. It is important to talk with your doctor about any questions you have around the general statistics provided below and what they may mean for you individually. The original sources for these statistics are provided at the bottom of this page

How many people are diagnosed with eye melanoma?

In 2023, an estimated 3,490 adults (1,900 men and 1,590 women) in the United States will be diagnosed with primary intraocular cancer. The risk for this disease increases with age. 

Most new cases of primary intraocular cancer this year will be melanoma. The number of people diagnosed with uveal melanoma has remained constant for the past few decades. However, the number of people diagnosed with conjunctival melanoma has increased during this time. White people are much more likely to be diagnosed with eye melanoma than Black people. 

It is estimated that 430 deaths (240 men and 190 women) from primary intraocular cancer will occur in the United States in 2023. 

What is the survival rate for eye melanoma?

There are different types of statistics that can help doctors evaluate a person’s chance of recovery from eye melanoma. These are called survival statistics. A specific type of survival statistic is called the relative survival rate. It is often used to predict how having cancer may affect life expectancy. Relative survival rate looks at how likely people with eye melanoma are to survive for a certain amount of time after their initial diagnosis or start of treatment compared to the expected survival of similar people without this cancer.

Example: Here is an example to help explain what a relative survival rate means. Please note this is only an example and not specific to this type of cancer. Let’s assume that the 5-year relative survival rate for a specific type of cancer is 90%. “Percent” means how many out of 100. Imagine there are 1,000 people without cancer, and based on their age and other characteristics, you expect 900 of the 1,000 to be alive in 5 years. Also imagine there are another 1,000 people similar in age and other characteristics as the first 1,000, but they all have the specific type of cancer that has a 5-year survival rate of 90%. This means it is expected that 810 of the people with the specific cancer (90% of 900) will be alive in 5 years.

It is important to remember that statistics on the survival rates for people with eye melanoma are only an estimate. They cannot tell an individual person if cancer will or will not shorten their life. Instead, these statistics describe trends in groups of people previously diagnosed with the same disease, including specific stages of the disease.

The 5-year relative survival rate for eye cancer in the U.S. is 80%. If the cancer is diagnosed at an early stage, the 5-year relative survival rate is 85%. About 73% of people are diagnosed at this stage.

The survival rates for eye melanoma vary based on several factors. These include the stage of cancer, a person’s age and general health, and how well the treatment plan works. Other factors that can affect outcomes include the type of eye melanoma diagnosed. 

The 5-year relative survival rate for eye melanoma is 82%. When melanoma does not spread outside the eye, the 5-year relative survival rate is about 85%. The 5-year relative survival rate for those with disease that has spread to surrounding tissues, organs, and/or the regional lymph nodes is 66%. If the melanoma has spread to distant parts of the body, the 5-year relative survival rate is 15%. Only 2% to 3% of primary eye cancer is diagnosed at this late stage. 

Iris melanoma is rare and does not usually spread. The 5-year relative survival rate for people with iris melanoma is more than 95%.   

Choroidal melanoma is the most common type of intraocular melanoma.  

  • The 5-year relative survival rate for people with small choroidal melanoma is 84%. 

  • The 5-year relative survival rate for people with medium choroidal melanoma is 68%. 

  • The 5-year relative survival rate for people with large choroidal melanoma is 47%. 

Ciliary body melanoma is rare. The 5-year relative survival rates are hard to determine for this type of melanoma, although it has a poorer prognosis than iris melanoma. Prognosis is the chance of recovery. 

Experts measure relative survival rate statistics for eye melanoma every 5 years. This means the estimate may not reflect the results of advancements in how eye melanoma is diagnosed or treated from the last 5 years. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts & Figures 2017; the ACS website; the National Cancer Institute website; and the Ocular Melanoma Foundation website. Additional source was Houle, Virginie, et al. “AIRP Best Cases in Radiologic-Pathologic Correlation: Choroidal Melanoma,” RadioGraphics 2011 31:1231-236. (All sources accessed February 2023). 

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by eye melanoma. Use the menu to choose a different section to read in this guide.  

Eye Melanoma - Medical Illustrations

Approved by the Cancer.Net Editorial Board, 01/2023

ON THIS PAGE: You will find drawings of the main body parts affected by eye melanoma. Use the menu to see other pages.

illustration of eye and eyeball

The outer part of the eye is made up of the sclera, retina, and uvea. The sclera is the outer wall of the eyeball. The retina is the thin layer that lines the eyeball and is connected to the optic nerve. The uvea consists of the choroid, the iris, and the ciliary body. The choroid is a layer of tissue above the retina. The iris is the colored part of the eye. Around and under the iris is the ciliary body. In the center of the iris is the pupil. The iris and pupil are covered and protected by a clear cornea. Copyright 2003 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

The next section in this guide is Risk Factors. It describes the factors that may increase the chance of developing eye melanoma. Use the menu to choose a different section to read in this guide.

Eye Melanoma - Risk Factors

Approved by the Cancer.Net Editorial Board, 01/2023

ON THIS PAGE: You will find out more about the factors that increase the chance of developing eye melanoma. Use the menu to see other pages.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a person’s risk of developing eye melanoma:

  • Age. The risk of eye melanoma increases as people get older. The disease is rare in children.

  • Race. Eye melanoma is more common in White people than in Black, Hispanic, or Asian American people.

  • Gender. Some studies show that eye melanoma affects men slightly more than women.

  • Eye and skin color. People with light eyes, such as blue or green, are more likely to be diagnosed with uveal melanoma than people with darker eyes. Fair skin color is also a risk factor for uveal melanoma.

  • Individual history. People with certain medical conditions have a higher risk of developing eye melanoma. People with the following medical conditions have a higher risk of developing uveal melanoma:

    • Ocular or oculodermal melanocytosis. This pigmentation of the eye or skin around the eye increases the risk of uveal melanoma. Doctors also call it nevus of Ota.

    • Nevi. These mole-like spots in the eye have been associated with a higher risk of uveal melanoma. In addition, up to 26% of conjunctival melanoma is thought to arise from a nevus.

    • Dysplastic nevus syndrome. This condition, which is associated with uveal cancer, is marked by multiple flat moles on the skin that are not the same shape or color. Dysplastic nevus syndrome also increases the risk of melanoma of the skin.

    Meanwhile, people with the following medical condition have a higher risk of developing conjunctival melanoma:

    • Primary acquired melanosis (PAM). These flat, brown spots on the eye can increase the risk for conjunctival melanoma. Some studies show that approximately 57% to 76% of cases are associated with PAM.

  • Family history. Uveal melanoma can run in families, although it is rare. Usually, a family history is due to a mutation in a gene called BAP1. A mutation is a change in the gene. The BAP1 mutation is strongly linked with metastatic uveal melanoma. This mutation is also seen in other types of cancer, such as kidney cancer and mesothelioma.

  • Other factors. Some studies suggest that too much sunlight may be a risk factor for uveal melanoma and conjunctival melanoma. Other studies suggest that working as a welder may increase the risk for choroidal and ciliary body melanomas. However, the data are not conclusive about either of these associations.

People with a combination of these risk factors may benefit from seeing an ophthalmologist for a yearly examination. They should also consider protecting their eyes from ultraviolet (UV) radiation with sunglasses. Anyone who finds unusual moles or other skin growths around the eye or elsewhere on the body should see a dermatologist. This is a doctor who specializes in skin diseases. This is especially important if there is a family history of melanoma.

The next section in this guide is Symptoms and Signs. It explains what changes or medical problems eye melanoma cancer can cause. Use the menu to choose a different section to read in this guide.

Eye Melanoma - Symptoms and Signs

Approved by the Cancer.Net Editorial Board, 01/2023

ON THIS PAGE: You will find out more about changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

People with eye melanoma may experience the following symptoms or signs. Symptoms are changes that you can feel in your body. Signs are changes in something measured, like by taking your blood pressure or doing a lab test. Together, symptoms and signs can help describe a medical problem. However, many people do not experience any of these changes when they are diagnosed with eye melanoma. Or, the cause of a symptom or sign may be a different medical condition that is not cancer. Many times, an ophthalmologist finds eye melanoma during a routine eye examination.

Symptoms of uveal melanoma can include:

  • Complete or partial loss of vision

  • Blurred vision or double vision

  • Seeing floating spots, squiggly lines, or flashes of light

  • Change in the size or shape of the pupil (the dark circle in the center of the iris)

  • Change in how the eyeball is positioned or moves in the eye socket

  • Eye soreness or, in rare cases, pain

  • Bulging of the eye

  • Redness of the eye

  • A dark spot growing on the iris. Unlike choroidal and ciliary body melanomas, iris melanoma can sometimes be seen without looking inside the eye.

The most common symptom of conjunctival melanoma is a pigmented spot or lump. The lump is typically visible for conjunctival melanoma without looking inside the eye. However, the doctor will need to look into the eye for ciliary body or choroidal melanoma. Rarely, irritation and pain may occur.

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you have been experiencing the symptom(s), in addition to other questions. This is to help figure out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. Managing symptoms may also be called “palliative care” or “supportive care.” It is often started soon after diagnosis and continued throughout treatment. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to read in this guide.

Eye Melanoma - Diagnosis

Approved by the Cancer.Net Editorial Board, 01/2023

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. However, a biopsy is not required to confirm the diagnosis of uveal melanoma before treatment. It can often be diagnosed instead through an eye examination or imaging tests. Clinical examination by an ocular oncologist is the gold standard to diagnose and plan treatment for eye melanoma. The doctor may recommend biopsy in rare cases where the diagnosis is uncertain. More commonly, the doctor may recommend biopsy at the time of treatment to obtain tissue for prognostic genetic testing, which is the standard of care according to the National Comprehensive Cancer Network’s guidelines on uveal melanoma. Please note that this link will take you to another, independent website.

How eye melanoma is diagnosed

There are many tests used for diagnosing eye melanoma. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and general health

  • The results of earlier medical tests

In addition to a physical examination, the following tests may be used to diagnose eye melanoma:

Dilated eye examination

Most eye melanoma is found during a routine dilated eye examination before symptoms appear. During the exam, the doctor will dilate, or widen, the pupil with eye drops. This allows them to carefully examine the eye, including the retina and optic nerve. The doctor will view the eye with a lighted instrument called an ophthalmoscope. They may also use a slit lamp, which is a microscope with a light attached to it. A special lens may be placed on the eye to look at the eye’s drainage system. This test is called a gonioscopy.

Imaging tests

Imaging tests show pictures of the inside of the body. They can show if cancer has spread.

In-office tests

  • Fundus photography: Using special cameras, the eye lesion is photographed to allow for careful documentation of the lesion, its borders, and how close it is to important vision structures. The pictures allow for detailed follow-up to assess any growth or change in a suspected lesion. They also help the doctor monitor your response to therapy.

  • Optical coherence tomography (OCT). This non-invasive procedure uses light waves to create detailed, cross-section pictures of the retina and choroid. It can be used to image smaller choroidal tumors and to monitor the eye for side effects from treatments.

  • Ultrasound. An ultrasound uses high frequency sound waves to create pictures of the eye and is used to get details of the tumors located in the back of the eye. A small device called a transducer is painlessly placed on the eye surface. Sound waves sent through the transducer bounce back when they reach the eye organs. The transducer turns the sound waves into images. In some cases, a different ultrasound probe is use to get more detailed images of lesions in the front of the eye. This test is called high-resolution ultrasound biomicroscopy.

  • Fluorescein angiography. This procedure takes a picture of the blood vessels in the eye. A fluorescent dye called fluorescein is injected into the arm. The dye moves through the body and into the blood vessels in the back of the eye. The doctor then takes several quick pictures of the eye. It may help the doctor to confirm the ocular tumor, monitor side effects of treatment, and may also be used to rule out eye problems other than cancer. Indocyanine green angiography is a similar test that uses a different dye called indocyanine green.

  • Transillumination. Using a bright light source (similar to a thin flashlight), the bright light is shone onto the side of the eye to help highlight the location of a suspected tumor.

Radiology tests

The tests below are rarely used to diagnose an ocular tumor. Rather, they are used once the melanoma is diagnosed to check for signs of metastatic disease and to follow patients for future metastatic disease.

  • Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the head using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Usually, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye is typically injected into a patient’s vein. Sometimes, it can also be given as a pill or liquid to swallow.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the inside of the head. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

  • Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body.

Biopsy and tissue testing

  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

    Doctors can often diagnose most cases of uveal melanoma without a biopsy. If conjunctival melanoma or orbital melanoma is suspected, a biopsy can make a definitive diagnosis. However, a biopsy may have risk associated with it and cannot be done for all patients.

    There are different ways to collect a tissue sample, including:

    • Fine needle biopsy. A thin needle is used to remove a small sample of cells.

    • Incisional biopsy. Part of the entire suspicious area is removed.

    • Excisional biopsy. The entire suspicious area is removed. This type of biopsy is commonly used to diagnose conjunctival eye melanoma.

  • Genetic tissue testing. Genetic tests can be done on a uveal melanoma tissue sample removed during a biopsy or surgery. These tests can provide information about how likely the cancer is to spread from the eye to other parts of the body. In some situations, an older tissue sample that was previously removed and preserved can be used for testing.

    Genetic tests that may be done on uveal melanoma samples are:

    • Cytogenetic analysis. This test analyzes a cell’s chromosomes, which contain strands of DNA. The number, size, shape, and arrangement of the chromosomes are examined. Alterations in certain chromosomes, including chromosomes 1, 3, 6, and 8, can help predict how likely a uveal tumor is to metastasize. An alteration in chromosome 3 results in metastatic uveal melanoma in most patients. Approximately 50% of people with uveal melanoma will have this alteration.

      In addition, mutations in the BAP1 gene located on chromosome 3 are found in approximately 50% of uveal melanoma tumors. This mutation is associated with a high risk of metastasis. Mutations in other genes associated with uveal cancer, such as the SF3B1, EIF1AX, and PRAME genes, have a better prognosis.

    • Gene expression profiling. This test identifies specific genes, proteins, and other factors unique to the tumor. Sometimes, eye melanomas are categorized into “class 1” or “class 2” tumors. These classes can help determine the risk of the cancer spreading 5 years after diagnosis. Class 1 tumors have a low risk of spreading. Class 2 tumors have a high risk of spreading.

    These tests can help a patient understand their risk for metastasis. They can also influence how closely the person is monitored during and after treatment. Researchers are still working to develop treatments that prevent metastasis from occurring (see the Latest Research section). Before your treatment begins, talk with your doctor about the risks and benefits of having 1 of these tests and what the results could mean for your care. Patients who receive radiation therapy for uveal melanoma (see the Types of Treatment section) are not able to have a biopsy in the future.

    The results of genetic testing may be combined with other factors that inform uveal melanoma prognosis, such as tumor size, tumor location, and the age of the person at diagnosis. Additional information about prognosis for uveal eye melanoma and conjunctival melanoma can be found in the Stages and Grades section.

Tests for metastatic eye melanoma

If eye melanoma is diagnosed, your doctor may recommend tests to see if the disease has spread outside of the eye to other areas of the body.

Spread to the liver is examined by testing the levels of liver enzymes in a person’s blood or through a CT scan, MRI, or an ultrasound of the liver. The doctor may also recommend a chest PET scan or x-ray to check if the cancer has spread to the lung. An x-ray is a way to create a picture of the structures inside of the body using a small amount of radiation. A brain MRI and other tests may also be considered. For people diagnosed with conjunctival melanoma, a PET scan can look for spread to the lymph nodes.

After all diagnostic tests are done, your doctor will review the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging and grading.

The next section in this guide is Stages and Grades. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

Eye Melanoma - Stages and Grades

Approved by the Cancer.Net Editorial Board, 01/2023

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread, as well as the way the tumor cells look when viewed under a microscope. This is called the stage and grade. Use the menu to see other pages.

What is cancer staging?

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body.

Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor recommend the best kind of treatment, and it can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

Staging can be clinical or pathological. Clinical staging is based on the results of tests done before surgery, which may include physical examinations and imaging tests. Pathological staging is based on what is found during surgery, including a biopsy. In general, pathological staging provides the most information to determine a patient’s prognosis.

This page provides detailed information about the system used to find the stage of eye melanoma and the stage groups for eye melanoma, such as stage I or stage IIIB.

TNM staging system for uveal melanoma

One tool that doctors use to describe the stage is the TNM system. Medical oncologists use this system, but your ophthalmologist may not. Talk with your doctor about the description of your tumor. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer spread to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person.

There are 5 stages of uveal melanoma: stage 0 (zero) and stages I through IV (1 through 4). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments. Ophthalmologists who do not use the TNM system to stage uveal melanoma still consider the size of the tumor when deciding on a treatment plan. They also consider how the tumor is affecting a person’s vision.

For uveal melanoma, T for an iris melanoma is described differently than T for choroidal and ciliary body melanomas and conjunctival melanomas. N and M are described the same for iris, choroidal, and ciliary body melanomas. They are described differently for conjunctival melanoma.

Tumor (T)

Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Tumor size is measured in centimeters (cm). A centimeter is roughly equal to the width of a standard pen or pencil.

Stage may also be divided into smaller groups that help describe the tumor in even more detail. The following classifications are the same for any type of uveal melanoma:

TX: The primary tumor cannot be evaluated.

T0: There is no tumor in the eye.

Iris melanoma

An iris tumor is classified as T1, T2, T3, or T4. Each classification may also be divided into smaller groups that help describe the tumor in even more detail.

T1: The tumor is limited to the iris.

  • T1a: The tumor is in 1 quadrant (one-fourth) or less of the iris.

  • T1b: The tumor is in more than 1 quadrant of the iris.

  • T1c: The tumor is only in the iris, but there is melanomalytic glaucoma. This means that a buildup of certain cells in the eye blocks the flow of fluid in the eye, which causes pressure.

T2: The tumor has joined or grown into the ciliary body and/or choroid.

  • T2a: The tumor has joined or grown into the ciliary body.

  • T2b: The tumor has joined or grown into the ciliary body and choroid.

  • T2c: The tumor has joined or grown in the ciliary body and/or choroid and is causing melanomalytic glaucoma.

T3: The tumor has joined or grown into the ciliary body and/or choroid and extends to the sclera.

  • T3a: The tumor has joined or grown into the ciliary body and/or choroid and extends to the sclera in association with melanomalytic glaucoma.

T4: The tumor has spread to the outside of the eyeball, the optic nerve, or the eye socket. This is called extraocular extension.

  • T4a: The tumor has spread less than 5 millimeters (mm) outside of the eye.

  • T4b: The tumor has spread more than 5 mm outside of the eye.

Ciliary body and choroid melanoma

A tumor in the ciliary body and choroid is also classified as T1, T2, T3, or T4 based on the size of the tumor. The size is measured in optic disc diameters or millimeters. The tumor is measured for both width and height. This is also called thickness. A tumor is given a classification according to the table below, based on its width and height.

Your doctors may use and refer to this classification, called a category, even more than the stage. This is because the size and thickness of the tumor (the T) is most important for finding out a patient’s prognosis.

Size Category Classification Table for Ciliary Body and Choroid Melanoma

Thickness (mm)

Category

Thicker than 15 mm

4

4

4

12.1 to 15.0

3

3

4

4

9.1 to 12.0

3

3

3

3

3

4

6.1 to 9.0

2

2

2

2

3

3

4

3.1 to 6.0

1

1

1

2

2

3

4

Less than 3.0

1

1

1

1

2

2

4

Largest basal diameter (mm)

Less than 3.0 mm

3.1 to 6.0 mm

6.1 to 9.0 mm

9.1 to 12.0 mm

12.1 to 15.0 mm

15.1 to 18.0 mm

Larger than 18.0 mm

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois.

T1: The tumor is size category 1.

  • T1a: The tumor is size category 1 and does not involve the ciliary body or other parts of the eye.

  • T1b: The tumor is size category 1 and involves the ciliary body.

  • T1c: The tumor is size category 1 that does not involve the ciliary body, but there is a very small area (5 mm or less in diameter) of visible spread beyond the eyeball. This is called extraocular spread.

  • T1d: The tumor is size category 1 that involves the ciliary body with extraocular spread less than 5 mm.

T2: The tumor is size category 2.

  • T2a: The tumor is size category 2 and does not involve the ciliary body or other parts of the eye.

  • T2b: The tumor is size category 2 and involves the ciliary body.

  • T2c: The tumor is size category 2 that does not involve the ciliary body, but there is a very small area (5 mm or less in diameter) of visible spread beyond the eyeball.

  • T2d: The tumor is size category 2 that involves the ciliary body with extraocular spread less than 5 mm.

T3: The tumor is size category 3.

  • T3a: The tumor is size category 3 and does not involve the ciliary body or other parts of the eye.

  • T3b: The tumor is size category 3 and involves the ciliary body.

  • T3c: The tumor is size category 3 that does not involve the ciliary body, but there is a very small area (5 mm or less in diameter) of visible spread beyond the eyeball.

  • T3d: The tumor is size category 3 that involves the ciliary body with extraocular spread less than 5 mm.

T4: The tumor is size category 4.

  • T4a: The tumor is size category 4 and does not involve the ciliary body or other parts of the eye.

  • T4b: The tumor is size category 4 and involves the ciliary body.

  • T4c: The tumor is size category 4 that does not involve the ciliary body, but there is a very small area (5 mm or less in diameter) of visible spread beyond the eyeball.

  • T4d: The tumor is size category 4 that involves the ciliary body with extraocular spread less than 5 mm.

  • T4e: The tumor is any size category with extraocular spread of more than 5 mm in diameter.

Conjunctival melanoma

A tumor in the conjunctiva is also classified as T1, T2, T3, or T4 based on the size of the tumor. The following are the classifications for conjunctival melanoma:

T1: The tumor is in the bulbar conjunctiva.

  • T1a: The tumor is in less than 1 quadrant of the bulbar conjunctiva.

  • T1b: The tumor is in at least 1 quadrant of the bulbar conjunctiva but not more than 2.

  • T1c: The tumor is in at least 2 quadrants of the bulbar conjunctiva but not more than 3.

  • T1d: The tumor is in at least 3 quadrants of the bulbar conjunctiva.

T2: The tumor is in the nonbulbar conjunctiva and has possibly spread to the caruncle, which is the small, pink spot in the inner corner of the eye.

  • T2a: The tumor is in at most 1 quadrant of the nonbulbar conjunctiva and has not spread to the caruncle.

  • T2b: The tumor is in more than 1 quadrant of the nonbulbar conjunctiva and has not spread to the caruncle.

  • T2c: The tumor is in at most 1 quadrant of the nonbulbar conjunctiva and has spread to the caruncle.

  • T2d: The tumor is in more than 1 quadrant of the nonbulbar conjunctive and has spread to the caruncle.

T3: The tumor is any size and has spread to nearby structures of the eye.

  • T3a: The tumor has spread to the globe.

  • T3b: The tumor has spread to the eyelid.

  • T3c: The tumor has spread to the orbit.

  • T3d: The tumor has spread to the nasolacrimal duct, lacrimal sac, and/or paranasal sinuses.

T4: The tumor is any size and has spread to the central nervous system.

Node (N)

The “N” in the TNM staging system stands for lymph nodes. These small, bean-shaped organs help fight infection. Lymph nodes near where the cancer started are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. N is described the same for melanomas of the iris, ciliary body, choroid, and conjunctiva. However, for conjunctival melanoma, N1a and N1b do not apply.

NX: The regional lymph nodes cannot be evaluated.

N0 (N zero): The cancer has not spread to the regional lymph nodes.

N1: The cancer has spread to regional lymph nodes or the cancer has spread elsewhere.

  • N1a: The cancer has spread to regional lymph nodes.

  • N1b: The cancer has not spread to regional lymph nodes, but it has spread to other parts of the eye.

Metastasis (M)

The “M” in the TNM system describes whether the cancer has spread to other parts of the body, which is called metastasis. M is described the same for iris, ciliary body, choroidal, and conjunctival melanomas. However, for conjunctival melanoma, M1a, M1b, and M1c do not apply.

MX: Distant metastasis cannot be evaluated.

M0 (M zero): There is no distant metastasis.

M1: There is metastasis to other parts of the body.

  • M1a: There is metastasis to other parts of the body and the largest metastasis is 3 centimeters (cm) or less in diameter.

  • M1b: There is metastasis to other parts of the body and the largest metastasis is between 3.1 cm and 8 cm in diameter.

  • M1c: There is metastasis to other parts of the body and the largest metastasis is larger than 8.1 cm in diameter.

Return to top

Grade (G) and histopathology

Doctors also describe eye melanoma by its grade (G). The grade describes how much cancer cells look like healthy cells when viewed under a microscope.

The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancerous tissue looks similar to healthy tissue and has different cell groupings, it is called “differentiated” or a “low-grade tumor.” If the cancerous tissue looks very different from healthy tissue, it is called “poorly differentiated” or a “high-grade tumor.” The cancer’s grade may help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.

After a biopsy or when the tumor is surgically removed, doctors may look at the types of cells that are in the tumor. This is called histopathology. Three types of histopathology patterns may be present in the tumor:

  • Spindle cell melanoma (the cells are longer and tapered at the ends)

  • Epithelioid melanoma (the cells are oval-shaped)

  • Mixed cell melanoma (both spindle and epithelioid)

Generally, a tumor made up of spindle cells has a better prognosis than a tumor made up of epithelioid cells. The tumor is given a grade to describe the composition of its cells. A lower grade generally indicates a better prognosis than a higher grade.

GX: Grade cannot be evaluated

G1: A spindle cell melanoma

G2: A mixed cell melanoma

G3: An epithelioid melanoma

Return to top

Stage groups for eye melanoma

Doctors combine the T, N, M, and G information to say what stage the cancer is.

Stage I: The tumor is size category 1 and does not involve the ciliary body or other parts of the eye, nor has it spread to the regional lymph nodes or to other areas of the body (T1a, N0, M0).

Stage IIA: The tumor is a size category 1 that may or may not involve the ciliary body, with or without extraocular extension. Or, it is a size category 2 that does not involve the ciliary body. There is no spread to the regional lymph nodes or to other areas of the body (T1b, T1c, T1d, or T2a; N0, M0).

Stage IIB: The tumor is a size category 2 that involves the ciliary body but has not spread beyond the eyeball. Or, it is a size category 3 that has not spread to the ciliary body or eyeball. It has not spread to the regional lymph nodes or to other areas of the body (T2b or T3a; N0, M0).

Stage IIIA: Stage IIIA describes any one of these conditions:

  • A tumor of size category 2 with extraocular spread to a diameter of 5 mm or less, with or without ciliary body involvement, that has not spread to the lymph nodes or to other parts of the body (T2c or T2d, N0, M0).

  • A tumor of size category 3 that may or may not involve the ciliary body, with or without extraocular spread to a diameter of 5 mm or less, and has not spread to the lymph nodes or to other parts of the body (T3b or T3c, N0, M0).

  • A tumor of size category 4 that does not involve the ciliary body and has not spread to the lymph nodes or to other parts of the body (T4a, N0. M0).

Stage IIIB: Stage IIIB describes any one of these conditions:

  • The tumor is a size category 3 with ciliary body involvement and extraocular spread that has not spread to the lymph nodes or to other parts of the body (T3d, N0, M0).

  • The tumor is a size category 4 with or without ciliary body involvement that may or may not have spread outside the eyeball. It has not spread to the regional lymph nodes or to other areas of the body (T4b or T4c, N0, M0).

Stage IIIC: The tumor is a size category 4 that involves the ciliary body and has spread outside the eyeball. However, it has not spread to the regional lymph nodes or to other areas of the body (T4d or T4e; N0, M0).

Stage IV: This stage describes a tumor of any size that has spread to the lymph nodes and/or to other parts of the body outside of the eye (any T, N1, M0; or, any T, any N, M1).

Recurrent: Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Used with permission of the American College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017), published by Springer International Publishing.

Return to top

COMS tumor classifications

Instead of describing using the TNM system, uveal melanoma can also be classified by these guidelines from the Collaborative Ocular Melanoma Study (COMS).

  • Small: 1 mm to 3 mm in height and 5 mm to 16 mm in diameter

  • Medium: 3.1 mm to 8 mm in height and not more than 16 mm in diameter

  • Large: More than 8 mm in height and more than 16 mm in diameter

Return to top

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.

Eye Melanoma - Types of Treatment

Approved by the Cancer.Net Editorial Board, 01/2023

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with eye melanoma. Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for eye melanoma. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials are an option. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How eye melanoma is treated

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. In addition to an ophthalmologist (see Introduction), the health care team may include these individuals:

  • Radiation oncologist: A doctor who specializes in treating cancer with radiation therapy.

  • Surgical oncologist: A doctor who specializes in treating cancer with surgery.

  • Medical oncologist: A doctor who specializes in treating cancer with medication.

  • Reconstructive/plastic surgeon: A doctor who specializes in reconstructive surgery done to help repair damage caused by cancer treatment.

Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Treatment options and recommendations depend on several factors, including:

  • The type and stage of eye melanoma

  • Possible side effects, including the loss of vision in the eye being treated

  • Status of vision in the unaffected eye

  • The patient’s preferences and overall health

Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Learn more about making treatment decisions.

The main goals for treating eye melanoma are to reduce the risk of the cancer spreading and to maintain the health and vision of the patient’s eye whenever possible.

The common types of treatments used for eye melanoma are described below. Your care plan also includes treatment for symptoms and side effects, an important part of cancer care.

Active surveillance

Active surveillance may be an option if a uveal melanoma is very small or slow growing. This approach may also be used if treating the cancer would cause more discomfort than the disease itself. For example, it may be appropriate for people without any symptoms, older people, seriously ill people, or people with a tumor in their only useful eye. Active surveillance is sometimes called “observation” or “watchful waiting.”

During active surveillance, the patient is monitored closely by the health care team. Pictures of the tumor are used to track tumor size and the rate of growth. Active treatment would begin if the tumor shows signs of becoming more aggressive or spreading. If the tumor grows larger than 10 millimeters (mm) in diameter or 2 mm to 3 mm in height (thickness), then the doctor and the patient may decide to proceed with active treatment. Talk with your doctor about how often your eye should be checked if this approach is an option.

Return to top

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. This treatment is often recommended for small and medium uveal melanoma tumors.

When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. Most uveal melanomas in the United States are treated with brachytherapy. During a short operation, a small metal plaque is sewn on or near the tumor. The plaque delivers radiation directly into the tumor. Sometimes this is called “plaque therapy.”

Another common type of radiation treatment is called external-beam radiation therapy. This is radiation given from a machine outside the body. Traditional external-beam radiation therapy may also be used as an adjuvant therapy after surgery. Adjuvant therapy is treatment given after the main treatment. It may reduce the chance of cancer coming back by destroying any remaining cancer cells. Traditional external-beam radiation therapy may also be given as a palliative treatment (see below).

Proton beam therapy is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells. Proton beam therapy may be used to treat uveal tumors that are large or near the optic nerve. Learn more about proton therapy.

A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. Brachytherapy often lasts for several days before the plaque is removed. External-beam radiation therapy is typically done daily over the course of several days.

Using radiation therapy to treat the tumor may result in side effects such as vision loss. It is important to talk with your ophthalmologist about what to expect after treatment. However, treatment for eye melanoma using radiation therapy is continually improving.

The extent of the side effects depends on the type and dose of radiation therapy the person receives, where the tumor is located, and the patient’s general health. For larger tumors, there is more risk for side effects or complications from radiation therapy. The side effects may not show up right away, so let your doctor know if a problem arises. Be sure to ask what problems and signs to watch out for after being treated with radiation therapy.

Common side effects include:

  • Cataracts. A cataract is when the lens of the eye becomes cloudy. People with cataracts may have cloudy or foggy vision, have trouble seeing at night, or have problems with glare from the sun or bright lights. If the cataract is causing major problems with a person’s eyesight, it may be surgically removed. A cataract can develop 2 to 5 years after initial radiation therapy.

  • Loss of eyelashes and/or a dry eye. These side effects can occur with external-beam radiation therapy and proton-beam radiation therapy.

The following side effects are less common and can cause a loss of vision:

  • Radiation retinopathy: Abnormal blood vessels develop in the retina.

  • Radiation optic neuropathy: Optic nerve damage occurs.

  • Neovascular glaucoma: New blood vessels develop and block the outflow of fluid from the eye, causing this painful condition.

  • Loss of eye: If there is significant damage to the eye from radiation therapy, the eye may need to be removed.

Learn more about the basics of radiation therapy.

Return to top

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. This is also called surgical resection or surgical excision. An ophthalmologist typically performs eye surgery.

Surgery may be used to treat large uveal tumors or iris melanoma. During surgery, the ophthalmologist will remove part or all of the affected eye depending on the size and spread of the tumor.

Surgical options include:

  • Iridectomy: Removal of part of the iris. Very small iris melanomas may be removed with this type of surgery.

  • Iridocyclectomy: Removal of part of the iris and ciliary body. Very small iris melanomas may also be removed with this type of surgery.

  • Transscleral resection: Removal of a tumor in the choroid or ciliary body through the sclera. This surgery may be recommended for large tumors.

  • Enucleation: Removal of the eye. This surgery may be recommended for tumors that are large, cause severe pain or pressure, involve the optic nerve, or have already caused loss of vision.

  • Orbital exenteration: Removal of the eyeball as well as structures in the eye socket, such as the eyelid, muscle, nerves, and fat. This surgery may be used if a melanoma has spread from the eyeball into those structures.

Surgery is also used to place the radioactive plaque for brachytherapy (see “Radiation therapy,” above). Surgery may also be done after radiation therapy.

Potential side effects of eye surgery include a risk of infection, pain, and problems from the general anesthesia, which is the medication that blocks the awareness of pain used during surgery. In some cases, partial or total loss of vision in the eye can also occur immediately or sometime after surgery. With total removal of the eye, there is a slight risk that the tumor could come back in the orbit.

Many patients want to know immediately whether the surgery was successful. However, the success of an operation is hard to tell right away. It may take months before the doctors can determine if all of the cancer cells were removed during surgery.

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of cancer surgery.

Having an eye removed

Sometimes the only choice a doctor has in treating eye melanoma is to remove the eye, called enucleation. Because of this visual loss, a person with 1 eye may have trouble with depth perception. Most people adjust to this difference.

Many people worry about what they will look like when they have an eye removed. The cosmetic surgery available today usually yields good cosmetic results. To fill the area left by the missing eye, the person is fitted for a prosthesis called an artificial eye. The artificial eye will look and behave almost the same way as a natural eye. For example, the artificial eye will move along with the person’s remaining eye, just not as much as a natural eye moves. Family members may be able to tell that the eye is not real, but it is unlikely that strangers will know.

If eye removal is required, talk with your doctor about an artificial eye as soon as possible. It may take many weeks for you to receive one. Also, ask about support services that may be available to you to help adjust physically and emotionally to the loss of an eye. Learn more about rehabilitation.

Return to top

Laser therapy

Laser therapy uses heat in the form of a laser to shrink a smaller uveal tumor. It may also be called thermotherapy or transpupillary thermotherapy (TTT). This treatment potentially has fewer side effects than surgery or radiation therapy. When side effects occur, they may include retinal bleeding, retinal detachment, and blockage of small blood vessels in the retina. Laser therapy may also be used as adjuvant therapy after brachytherapy (see above).

Return to top

Immunotherapy (updated 08/2023)

Immunotherapy uses the body's natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells. In 2022, the FDA approved the immunotherapy tebentafusp-tebn for HLA-A*02:01-positive metastatic uveal melanoma or uveal melanoma that cannot be treated with surgery. It works by targeting a type of protein found in melanoma called gp100.

Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

Return to top

Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as surgery or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

Return to top

Treatment by type and stage of eye melanoma

Different treatments may be recommended for the different types of eye melanoma. The general options by type of eye melanoma are described below. For more detailed descriptions, see “How eye melanoma is treated,” above. Your doctor will work with you to develop a specific treatment plan based on your specific diagnosis and needs. In addition to standard treatments, talk with your doctor about clinical trials that are open to you, no matter the type or stage of the tumor.

Iris melanoma

Iris melanoma is not generally actively treated unless the tumor begins to grow. However, there can be exceptions. Examples of common treatment options are:

  • Active surveillance

  • Surgery (either iridectomy or iridocyclectomy)

  • Radiation therapy, including proton therapy or brachytherapy

  • Enucleation, if the tumor is too large to remove or it spreads beyond the eye

Small choroidal and ciliary body tumor

The following are some treatment options for a small choroidal or ciliary body tumor:

  • Active surveillance

  • Radiation therapy, including proton therapy or brachytherapy

  • Laser therapy

  • Surgical resection or enucleation

Active surveillance is a common treatment plan. However, patients and their doctors may choose another option depending on the location of the tumor or whether the tumor begins to grow.

Medium choroidal and ciliary body tumor

The 2 most common treatment options for medium-sized choroidal and ciliary body melanoma are radiation therapy, including proton therapy or brachytherapy, and enucleation. It is believed that there is no difference in survival rates between these 2 treatment methods for a medium-sized choroidal tumor.

Other treatment options for a medium-sized tumor may include surgery to remove the tumor or enrollment in a clinical trial (see Latest Research section).

In addition, the combination of laser therapy and radiation therapy is being used more frequently to treat this type of tumor. This is sometimes called “sandwich therapy.”

Large choroidal and ciliary body tumor

For a large tumor, radiation therapy or enucleation are the usual treatments. Results of the Collaborative Ocular Melanoma Study (COMS) revealed that patients had similar survival rates whether they received radiation therapy before enucleation or had their eye removed with no previous radiation treatment. Enrolling in a clinical trial may be another option for people with large choroidal and ciliary body tumors. Additional brachytherapy may also be an option.

Conjunctival melanoma

The most common treatment approach to conjunctival melanoma is a type of surgery called wide local excision and biopsy. During the excision, the tumor and a margin of healthy tissue around it are removed. This surgery may be followed by adjuvant therapy. Cryotherapy, which uses liquid nitrogen to freeze and kill cells, is often used.

Other adjuvant therapy options that your doctor may recommend include:

  • Topical chemotherapy (see Latest Research section), most commonly with mitomycin C

  • Interferon alfa-2b (Intron-A), an immunotherapy drug (see Latest Research section) applied topically or given by injection

  • Brachytherapy or external-beam radiation therapy

Advanced cases of conjunctival melanoma or multiple recurrences are sometimes treated with eye removal or orbital exenteration. No studies show that these treatments improve survival rates. However, they may be used as palliative therapy to reduce pain and other symptoms.

Orbital melanoma

Because orbital melanoma is so rare, treatment recommendations may vary. In general, surgery to remove the tumor is often used. Surgery is usually followed by adjuvant radiation therapy.

Extraocular extension melanoma

If an eye melanoma has spread to the outside of the eye, the optic nerve, or the eye socket, the doctor may recommend removal of the eye. Or, the doctor may perform a modified enucleation. This is the removal of the eyeball and nearby structures. In some cases, the doctor may recommend exenteration to remove the entire eye and the nearby structures. If the spread is small, some doctors will try to save the eye by removing the outer part of the tumor and treating the eye with radiation therapy.

Talk with your doctor about possible treatment options, potential side effects, and clinical trials open to you before choosing a treatment plan.

Metastatic eye melanoma

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. For example, metastatic uveal melanoma often spreads from the eye to the liver. If you have metastatic eye melanoma, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Your treatment plan may include a combination of treatments. For eye melanoma that spreads to the liver, treatments such as surgery or radiation therapy may be recommended. Ablation, which uses heat or cold to destroy cancer cells, and drug injections may also be options. Radiation therapy, ablation, and, in some cases, systemic chemotherapy may be used to treat eye melanoma that spreads to the lungs or other parts of the body. Systemic therapy is the use of medication to destroy cancer cells.

Some patients may enroll in clinical trials that are testing other treatments, such as immunotherapy and targeted therapy, for metastatic eye melanoma. (See Latest Research.) Palliative care will also be important to help relieve symptoms and side effects.

For many people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

Return to top

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer returns after the original treatment, it is called recurrent cancer. Approximately 50% of uveal melanomas recur after treatment. An estimated 36% to 56% of conjunctival melanomas will also come back. A tumor may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

If a recurrence happens, a new cycle of testing will begin again to learn as much as possible about it. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above, such as surgery or radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat recurrent eye melanoma. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.

Return to top

If treatment does not work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

Return to top

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

Eye Melanoma - About Clinical Trials

Approved by the Cancer.Net Editorial Board, 01/2023

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are studied to see how well they work. Use the menu to see other pages.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for people with eye melanoma. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. Every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

Clinical trials are used for all types and stages of eye melanoma. Many focus on new treatments to learn if a new treatment is safe, effective, and possibly better than the existing treatments. These types of studies evaluate new drugs, different combinations of treatments, new approaches to radiation therapy or surgery, and new methods of treatment.

People who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there are some risks with a clinical trial, including possible side effects and the chance that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects.

Deciding to join a clinical trial

People decide to participate in clinical trials for many reasons. For some, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Others volunteer for clinical trials because they know that these studies are a way to contribute to the progress in treating eye melanoma. Even if they do not benefit directly from the clinical trial, their participation may benefit future people with eye melanoma.

Insurance coverage and the costs of clinical trials differ by location and by study. In some programs, some of the expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” When used, placebos are usually combined with standard treatment in most cancer clinical trials. Study participants will always be told when a placebo is used in a study. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, people must participate in a process known as informed consent. During informed consent, the doctor should:

  • Describe all of the treatment options so that the person understands how the new treatment differs from the standard treatment.

  • List all of the risks of the new treatment, which may or may not be different from the risks of standard treatment.

  • Explain what will be required of each person in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

  • Describe the purposes of the clinical trial and what researchers are trying to learn.

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together. You will need to meet all of the eligibility criteria in order to participate in a clinical trial. Learn more about eligibility criteria in clinical trials.

People who participate in a clinical trial may stop participating at any time for personal or medical reasons. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that people participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if they choose to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for eye melanoma, learn more in the Latest Research section.

Cancer.Net offers more information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

PRE-ACT, Preparatory Education About Clinical Trials

In addition, you can find a free video-based educational program about cancer clinical trials located in another section of this website.

The next section in this guide is Latest Research. It explains areas of scientific research for eye melanoma. Use the menu to choose a different section to read in this guide.

Eye Melanoma - Latest Research

Approved by the Cancer.Net Editorial Board, 01/2023

ON THIS PAGE: You will read about the scientific research being done to learn more about eye melanoma and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about eye melanoma, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

  • Targeted therapy. Researchers are studying the genes, proteins, and other factors that may be involved in the development of eye melanoma. Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. Recent studies show that not all tumors have the same genes or proteins. Many research studies are taking place now to find out more about specific molecular features and develop new adjuvant and metastatic treatments for uveal and conjunctival melanoma.

    About 80% of uveal melanomas are associated with GNAQ or GNA11 gene mutations. A mutation is a change in the gene. MEK inhibitors are a type of targeted therapy being researched as a treatment for tumors with these mutations. Researchers also continue to study targeted therapies for gene mutations associated with conjunctival melanoma, including a mutation in the BRAF gene. This mutation appears in 30% to 50% all primary and metastatic conjunctival tumors.

    Learn more about the basics of targeted treatment.

  • Immunotherapy. Researchers are studying immunotherapy drugs alone, in combination with each other, and in combination with other drugs or therapies to find ways to prevent or treat uveal melanoma metastasis.

    Monoclonal antibodies, which specifically target and destroy cancer cells, are a type of immunotherapy being tested in clinical trials. For example, a combination of ipilimumab (Yervoy) and nivolumab (Opdivo) is being studied as an adjuvant therapy to prevent metastasis after the first treatment for uveal melanoma. Learn more about the basics of immunotherapy.

  • Chemotherapy. Chemotherapy is the use of drugs to destroy cancer cells. It usually works by keeping the cancer cells from growing, dividing, and making more cells. Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. For people with metastatic uveal melanoma, adjuvant chemotherapy treatment is being tested in clinical trials. Topical chemotherapy drugs, such as 5-fluorouracil (5-FU), bortezomib (Velcade), sorafenib (Nexavar), and others, are being studied as adjuvant therapy for conjunctival melanoma. Learn more about the basics of chemotherapy.

  • Improved radiation therapy. Many hospitals and cancer centers offer methods that focus radiation therapy to the tumor to help reduce damage to the rest of the eye. Researchers continue to investigate ways to make radiation therapy more effective for eye melanoma and to reduce side effects from the treatment. Some studies are looking at how radiation therapy works in combination with immunotherapy or other drugs.

  • Advances in surgery. Researchers are looking to see if sentinel lymph node biopsy can find microscopic lymph node disease in people with conjunctival melanoma before it becomes obvious. With this surgical technique, researchers could potentially identify metastatic disease that would otherwise go unnoticed until it is advanced.

  • Treating liver metastases. Because eye melanoma commonly metastasizes to the liver, many people need treatment to the liver. For instance, a clinical trial for metastatic eye melanoma is testing a technique called percutaneous hepatic perfusion (PHP) with the chemotherapy drug melphalan (Alkeran). This technique sends high doses of the chemotherapy directly into the liver.

  • Palliative care/supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current eye melanoma treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in eye melanoma, explore these related items that take you outside of this guide:

The next section in this guide is Coping with Treatment. It offers some guidance on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

Eye Melanoma - Coping with Treatment

Approved by the Cancer.Net Editorial Board, 01/2023

ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. Use the menu to see other pages.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people do not experience the same side effects even when they are given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. This part of cancer treatment is called palliative care or supportive care. It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for eye melanoma are described in the Types of Treatment section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

Talk with your health care team regularly about how you are feeling. It is important to let them know about any new side effects or changes in existing side effects. If they know how you are feeling, they can find ways to relieve or manage your side effects to help you feel more comfortable and potentially keep any side effects from worsening.

You may find it helpful to keep track of your side effects so it is easier to talk about any changes with your health care team. Learn more about why tracking side effects is helpful.

Sometimes, side effects can last after treatment ends. Doctors call these long-term side effects. Side effects that occur months or years after treatment are called late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-Up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects after a cancer diagnosis. This may include dealing with a variety of emotions, such as sadness, anxiety, or anger, or managing your stress level. Sometimes, people find it difficult to express how they feel to their loved ones. Some have found that talking to an oncology social worker, counselor, or member of the clergy can help them develop more effective ways of coping and talking about cancer.

You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with the costs of cancer care

Cancer treatment can be expensive. It may be a source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost of medical care stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Patients and their families are encouraged to talk about financial concerns with a member of their health care team. Learn more about managing financial considerations in a separate part of this website.

Coping with barriers to care

Some groups of people experience different rates of new cancer cases and experience different outcomes from their cancer diagnosis. These differences are called “cancer disparities.” Disparities are caused in part by real-world barriers to quality medical care and social determinants of health, such as where a person lives and whether they have access to food and health care. Cancer disparities more often negatively affect racial and ethnic minorities, people with fewer financial resources, sexual and gender minorities (LGBTQ+), adolescent and young adult populations, older adults, and people who live in rural areas or other underserved communities.

If you are having difficulty getting the care you need, talk with a member of your health care team or explore other resources that help support medically underserved people.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they likely to happen?

  • What can we do to prevent or relieve them?

  • When and who should we call about side effects?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you do not think the side effects are serious. This discussion should include physical, emotional, social, and financial effects of cancer.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with eye melanoma. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away. Being a caregiver can also be stressful and emotionally challenging. One of the most important tasks for caregivers is caring for themselves.

Caregivers may have a range of responsibilities on a daily or as-needed basis, including:

  • Providing support and encouragement

  • Talking with the health care team

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to and from appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

A caregiving plan can help caregivers stay organized and help identify opportunities to delegate tasks to others. It may be helpful to ask the health care team how much care will be needed at home and with daily tasks during and after treatment. Use this 1-page fact sheet to help make a caregiving action plan. This free fact sheet is available as a PDF, so it is easy to print.

Learn more about caregiving or read the ASCO Answers Guide to Caring for a Loved One With Cancer in English or Spanish.

Looking for More on How to Track Side Effects?

Cancer.Net Mobile app symptom tracker

Cancer.Net offers several resources to help you keep track of your symptoms and side effects. Please note that these links will take you to other sections of Cancer.Net:

  • Cancer.Net Mobile: The free Cancer.Net mobile app allows you to securely record the time and severity of symptoms and side effects.

  • ASCO Answers Managing Pain: Get this 32-page booklet about the importance of pain relief that includes a pain tracking sheet to help patients record how pain affects them. The free booklet is available as a PDF, so it is easy to print.

  • ASCO Answers Fact Sheets: Read 1-page fact sheets on anxiety and depression, constipation, diarrhea, and rash that provide a tracking sheet to record details about the side effect. These free fact sheets are available as a PDF, so they are easy to print, fill out, and give to your health care team.

The next section in this guide is Follow-Up Care. It explains the importance of checkups after you finish cancer treatment. Use the menu to choose a different section to read in this guide.

Eye Melanoma - Follow-Up Care

Approved by the Cancer.Net Editorial Board, 01/2023

ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. The purpose of follow-up care is to look for a spread of the disease or a recurrence. In general, people who have had eye melanoma should have regular checkups throughout their lifetime.

In general, people who have had radiation therapy or chose active surveillance are usually monitored every 3 to 6 months. Patients who had an eye surgically removed should receive a yearly eye examination. Their doctors should also monitor the orbit closely for the next 2 to 3 years after surgery. Your doctor can work with you to decide on an appropriate follow-up care plan.

Monitoring for signs of metastasis is an important part of your follow-up care, particularly for spread of the cancer to the liver or lungs. This process may include a physical examination, liver function blood tests, and imaging tests, such as a chest x-ray, ultrasound, computed tomography (CT) scan, or positron emission tomography (PET) scan, every 6 to 12 months. People treated for conjunctival melanoma may also have an imaging test done for their regional lymph nodes once a year. If a person is known to have a high-risk eye melanoma that is likely to recur or spread, the doctor may recommend more frequent monitoring. Your doctor can work with you to decide on an appropriate follow-up care plan.

Cancer rehabilitation may be recommended. This could mean any of a wide range of services, such as physical therapy, occupational therapy, pain management, and/or emotional counseling that helps a person cope with changes in their appearance or self-image. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible. Learn more about cancer rehabilitation.

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. Eye melanoma can recur several years after treatment. Between 6 to 12 months after treatment, it is important to check for recurrence or metastasis. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care. However, testing recommendations depend on several factors, including the type and stage of cancer first diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress.

Managing long-term and late side effects

Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. The American Society of Clinical Oncology (ASCO) offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their primary care doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

Eye Melanoma - Survivorship

Approved by the Cancer.Net Editorial Board, 01/2023

ON THIS PAGE: You will read about how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to see other pages.

What is survivorship?

The word “survivorship” is complicated because it means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and continues during treatment and through the rest of a person’s life.

For some, even the term “survivorship” does not feel right, and they prefer to use different language to describe and define their experience. Sometimes extended treatment will be used for months or years to manage or control cancer. Living with cancer indefinitely is not easy, and the health care team can help you manage the challenges that come with it. Everyone has to find their own path to name and navigate the changes and challenges that are the results of their cancer diagnosis and treatment.

Survivors may experience a mixture of feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain about coping with everyday life. Feelings of fear and anxiety may still occur as time passes, but these emotions should not be a constant part of your daily life. If they persist, be sure to talk with a member of your health care team.

Survivors may feel some stress when their frequent visits to the health care team end after completing treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true when new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexual health and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing

  • Thinking through solutions

  • Asking for and allowing the support of others

  • Feeling comfortable with the course of action you choose

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the place where you received treatment.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make lifestyle changes.

People recovering from eye melanoma are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, exercising regularly, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

It is important to have recommended medical checkups and tests (see Follow-Up Care) to take care of your health.

Talk with your health care team to develop a survivorship care plan that is best for your needs.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note that these links will take you to other sections of Cancer.Net:

  • ASCO Answers Guide to Cancer Survivorship: Get this 48-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The free booklet is available as a PDF, so it is easy to print.

  • Survivorship Resources: Cancer.Net offers information and resources to help survivors cope, including specific sections for children, teens and young adults, and people over age 65. There is also a main section on survivorship for people of all ages.

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. Use the menu to choose a different section to read in this guide.

Eye Melanoma - Questions to Ask the Health Care Team

Approved by the Cancer.Net Editorial Board, 01/2023

ON THIS PAGE: You will find some questions to ask your doctor or other members of the health care team, to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Cancer.Net Mobile app question tracker

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment. Or, download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

  • What type of eye melanoma do I have?

  • Do I need a biopsy? Why or why not?

  • If I had a biopsy, can you explain my pathology report (laboratory test results) to me?

  • What stage is the eye melanoma? If there’s a grade, what grade is it? What does this mean?

  • Do you recommend any additional diagnostic tests, such as cytogenetics or gene expression profiling?

  • Who can help me interpret the results of these tests?

  • What is the likelihood that the cancer will spread outside of the eye? How do you know?

  • Do I need treatment right away?

Questions to ask about choosing a treatment and managing side effects

  • What experience do you have in treating eye melanoma?

  • What are my treatment options?

  • What clinical trials are available for me? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • What are the possible side effects of each treatment, both in the short term and the long term?

  • Is loss of vision a possible side effect? If so, when could vision changes occur?

  • Who will be part of my health care team, and what does each member do?

  • Who will be leading my overall treatment?

  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

  • Could this treatment affect my sex life? If so, how and for how long?

  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

  • If I’m worried about managing the costs of cancer care, who can help me?

  • What support services are available to me? To my family?

  • If I have questions or problems, who should I call?

Questions to ask about having radiation therapy

  • What kind of radiation therapy is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What is the likelihood of having radiation damage to my eye?

  • What is the risk of vision loss?

  • What other side effects can I expect from this treatment?

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible long-term or late effects of having this treatment?

  • What can be done to prevent or relieve the side effects?

Questions to ask about having surgery

  • What type of surgery is recommended? Will lymph nodes be removed?

  • How long will the operation take?

  • How long will I be in the hospital?

  • Can you describe what my recovery from surgery will be like?

  • Will I have problems with my vision after the surgery, either immediately or in the long term?

  • What are the possible long-term or late side effects of having this surgery?

  • Who should I contact about any side effects I experience? And how soon?

Questions to ask about loss of an eye

  • How do I adjust to only having 1 eye?

  • How long will it take me to recover physically?

  • What rehabilitation services are available to help me cope with this?

  • How soon can I get an artificial eye?

  • When do I get an artificial eye?

  • How do I care for my artificial eye?

Questions to ask about planning follow-up care

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • What follow-up tests will I need, and how often will those tests be needed?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be leading my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources. It offers more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.

Eye Melanoma - Additional Resources

Approved by the Cancer.Net Editorial Board, 01/2023

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Eye Melanoma. Use the menu to go back and see other pages.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Eye Melanoma. Use the menu to choose a different section to read in this guide.