Diagnosis of Intraocular Melanoma

The following tests and procedures may be used to diagnose intraocular melanoma:
  • Eye exam with dilated pupil: An examination of the eye in which the pupil is dilated (enlarged) with medicated eyedrops to allow the doctor to look through the lens and pupil to the retina. The inside of the eye, including the retina and the optic nerve, is examined using an instrument that produces a narrow beam of light. This is sometimes called a slit-lamp exam. The doctor may take pictures over time to keep track of changes in the size of the tumor and how fast it is growing.
  • Indirect ophthalmoscopy: An examination of the inside of the back of the eye using a small magnifying lens and a light.
  • Ultrasound exam of the eye: A procedure in which high-energy sound waves (ultrasound) are bounced off the internal tissues of the eye to make echoes. Eye drops are used to numb the eye and a small probe that sends and receives sound waves is placed gently on the surface of the eye. The echoes make a picture of the inside of the eye. The picture, called a sonogram, shows on the screen of the ultrasound monitor.
  • Transillumination of the globe and iris: An examination of the iris, cornea, lens, and ciliary body with a light placed on either the upper or lower lid.
  • Fluorescein angiography: A procedure to look at blood vessels and the flow of blood inside the eye. An orange fluorescent dye (fluorescein) is injected into a blood vessel in the arm. As the dye travels through blood vessels of the eye, a special camera takes pictures of the retina and choroid to detect any blockage or leakage.
Factors Affecting Prognosis The prognosis (chance of recovery) and treatment options depend on the following:
  • The type of melanoma cells (how they look under a microscope).
  • The size of the tumor.
  • Which part of the eye the tumor is in (the iris, ciliary body, or choroid).
  • Whether the tumor has spread within the eye or to other places in the body.
  • The patient’s age and general health.
  • Whether the tumor has recurred (come back) after treatment.

Stages of Intraocular (Eye) Melanoma

The process used to find out if cancer has spread within the eye or to other parts of the body is called staging. The following tests and procedures may be used in the staging process:
  • Gonioscopy: An examination of the front part of the eye between the cornea and iris. A special instrument is used to check for blockages in the area where fluid drains out of the eye.
  • Ultrasound biomicroscopy: A procedure that uses high-energy sound waves to measure small tumors. The amount of detail is about the same as that of a low-power microscope. Tumors can be examined this way for shape, thickness, and signs that they have spread to nearby tissue.
  • Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
  • Liver function tests: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign the cancer has spread to the liver.
  • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs, such as the liver, and make echoes. The echoes form a picture of body tissues called a sonogram.
  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the liver or brain, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
The following sizes are used to describe intraocular melanoma: Small— The tumor is at least 5 millimeters in diameter and from 1 to 3 millimeters thick. Medium— The tumor is less than 16 millimeters in diameter and from 2 to 10 millimeters thick. Large— The tumor is at least 16 millimeters in diameter or more than 10 millimeters thick. Diffuse— The tumor is flat and grows widely across the uvea. Cancer spreads in the body through tissue, lymph system or blood. When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. Intraocular melanoma may spread to nearby tissues or to other parts of the body. If intraocular melanoma spreads to the optic nerve or nearby tissue of the eye socket, it is called extraocular extension. Intraocular melanoma may also be metastatic and spread to the liver, lung, or bone, or to areas under the skin. The stage will determine your treatment options for the intraocular melanoma.

Recurrent Intraocular (Eye) Melanoma

Recurrent intraocular melanoma is cancer that has recurred (come back) after it has been treated. The melanoma may come back in the eye, or in other parts of the body. If you have symptoms associated with intraocular melanoma, contact us to request an appointment with our oncology specialists to begin diagnostic testing.