Choroidal melanoma is a malignant tumor that develops in the choroid, the middle layer of the eye between the retina and the sclera. This type of melanoma occurs when melanocytes, the cells responsible for producing melanin (the pigment that gives color to the skin, hair, and eyes), grow uncontrollably.
Unlike other types of eye cancer, choroidal melanoma develops inside the eyeball, which can make it difficult to detect early. This tumor can vary in size and location, affecting vision and, in advanced cases, spreading to other parts of the body.
Symptoms of choroidal melanoma
The manifestation of choroidal melanoma can be subtle, especially in its early stages. Many patients do not experience obvious symptoms, highlighting the need for regular eye exams. As the tumor grows, it can interfere with visual function and cause a number of symptoms that should alert the patient:
Blurred or distorted vision
Loss of peripheral vision
Presence of dark spots or floaters in the visual field
Flashes of light (photopsias)
Eye pain (infrequent)
It is important to note that these symptoms are not exclusive to choroidal melanoma and can be caused by other eye conditions. However, if you experience any of these symptoms, it is essential to consult an ophthalmologist for a thorough examination.
Choroidal melanoma classification
The classification of choroidal melanoma is essential to determine tumor aggressiveness and guide treatment decisions. Several classification systems are used, including the TNM system and histological evaluation:
Size and location of the tumor: the TNM classification (Tumor, Node, Metastasis) is used to describe the extent of the primary tumor, the involvement of lymph nodes, and the presence of distant metastases.
Histological evaluation classifies choroidal melanoma according to its cellular characteristics, including the type of cells (spindle-shaped, epithelioid, or mixed) and the presence of specific vascular patterns.
Causes and factors of choroidal melanoma
The exact cause of choroidal melanoma is not fully known, but it is believed that a combination of genetic and environmental factors may be involved.
Although the exact cause of choroidal melanoma is still under study, several factors have been identified that can increase the risk of developing this disease:
Race: white people have a higher risk of developing choroidal melanoma.
Age: choroidal melanoma is more common in older adults.
Choroidal nevus: the presence of a choroidal nevus (mole in the choroid) may slightly increase the risk of developing melanoma.
Oculodermal melanocytosis (Nevus of Ota): this congenital condition, which causes bluish pigmentation in the skin and eye, is associated with an increased risk of choroidal melanoma.
Exposure to ultraviolet light: although the evidence is not conclusive, some studies suggest that exposure to ultraviolet light may increase the risk.
Genetic factors: although most choroidal melanomas are not hereditary, there is a small percentage of cases that may be related to hereditary genetic mutations.
If left untreated, choroidal melanoma can lead to serious complications that affect the health and quality of life of patients. It is crucial to seek early medical attention to minimize these risks:
Loss of vision: the growth of the tumor can damage the retina and other ocular structures, which can result in partial or total vision loss.
Retinal detachment: the tumor can cause fluid to accumulate under the retina, which can cause it to detach.
Neovascular glaucoma: the tumor can stimulate the growth of abnormal blood vessels in the eye, which can increase intraocular pressure and damage the optic nerve.
Metastasis:in advanced cases, choroidal melanoma can spread to other parts of the body, such as the liver, lungs, or bones.
If you experience any of the symptoms mentioned or have risk factors for choroidal melanoma, it is crucial that you consult an ophthalmologist for a thorough evaluation.
Diagnosis of choroidal melanoma
An accurate and early diagnosis is essential for the effective treatment of choroidal melanoma. The diagnostic process generally includes a combination of ophthalmological examinations and imaging tests:
Medical history and complete ophthalmologic examination: the doctor will gather information about your medical history and perform a complete eye exam, including the assessment of visual acuity, intraocular pressure, and eye movement.
Ophthalmoscopy: this examination allows the doctor to directly visualize the retina and choroid in search of abnormalities, such as the presence of a tumor. It is performed by dilating the pupil to obtain better visualization.
Ocular ultrasound: this technique uses sound waves to create images of the inside of the eye. Ultrasound can help determine the size, shape, and location of the tumor, as well as detect the presence of subretinal fluid or extraocular extension.
Fluorescein angiography (FA): in this procedure, a dye is injected into the bloodstream and photographs of the retina and choroid are taken to assess blood circulation and detect vascular abnormalities associated with the tumor.
Optical Coherence Tomography (OCT): this high-resolution imaging technique provides detailed images of the eye’s structures, including the retina, the choroid, and the tumor. OCT can help determine the size and extent of the tumor, as well as assess its impact on surrounding structures.
Biopsy: on rare occasions, a biopsy may be performed on the tumor to confirm the diagnosis. However, biopsy carries a risk of complications and is generally reserved for cases where the diagnosis is uncertain.
Treatments for choroidal melanoma
The treatment of choroidal melanoma depends on several factors, including the size and location of the tumor, the patient’s age and overall health status, and the presence of metastases. Treatment options may include:
Brachytherapy: this treatment involves placing a radioactive plaque near the tumor to destroy cancer cells. The plaque is sutured to the sclera and left in place for a specified period of time, usually several days.
Proton beam therapy: this treatment uses high-energy radiation to destroy cancer cells. The proton beam is directed at the tumor from outside the body, minimizing damage to surrounding tissues.
Transpupillary thermotherapy (TTT): this procedure uses heat to destroy tumor cells. An infrared laser is applied to the surface of the tumor, raising its temperature and destroying the cancer cells.
Local resection: in some cases, the tumor can be surgically removed, preserving as much of the eye as possible. This procedure may involve the resection of a portion of the choroid and the overlying retina.
Enucleation: in advanced cases or when other treatment options are not feasible, removal of the eye may be necessary. Enucleation is considered when the tumor is too large, has caused serious complications, or has spread outside the eye.
At HM Hospitales, a multidisciplinary team of healthcare professionals, including ophthalmologists, radiation oncologists, and medical oncologists, will work together to provide the best possible care for the patient.
Remember that this article is for informational purposes only and does not replace professional medical advice. If you suspect you have choroidal melanoma, consult a specialist to obtain an accurate diagnosis and an appropriate treatment plan tailored to your needs.
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