The early detection of ocular melanoma through complete ophthalmological examinations, which include fundus examination with pupil dilation, is fundamental to identify this tumor in time and to be able to design the most appropriate treatment and follow-up. This is explained by the ophthalmologist at the Fernández-Vega Ophthalmological Institute (IOFV), Álvaro Fernández-Vega, who warns that this pathology can develop without causing discomfort in its initial stages and be discovered only in a routine examination.
Coinciding with Melanoma Day, which is commemorated on May 23, the IOFV recalls that ocular melanoma, also called uveal melanoma, is the most common primary intraocular malignant tumor in adulthood and that, in its early stages, it may not cause obvious signs for the patient.
Although it is the most frequent primary intraocular tumor, globally it accounts for less than 5 percent of all melanomas, so it is considered a rare disease. In Europe, the estimated incidence ranges between 2 and 8 diagnoses per million inhabitants per year.
This type of cancer can occur in both men and women and is diagnosed more frequently in people over 60 years of age. Ocular melanoma is not considered a hereditary disease, but in most cases it is associated with mutations in the 6NAQ and GNA11 genes. Likewise, it has been linked to certain risk factors such as fair skin, light eyes, and conjunctival ocular melanocytosis.
"The objectives of the treatment are to preserve the eye and useful vision whenever possible. That is why we insist that a complete fundus examination, with the pupil dilated, can make a difference in the treatment," added Fernández-Vega.
This cancer originates in the cells that produce the pigment in the skin, hair, and eyes. In the case of ocular melanoma, most are located in the uvea, the middle layer of the eyeball (iris, ciliary body, and choroid), which is why they are also called uveal melanomas. Although it can appear in other ocular structures, the most common subtype is choroidal melanoma, located in an inner vascular layer of the eye.
The specialist also points out that risk factors exist such as advanced age, light eyes or skin, certain alterations in skin pigmentation, a history of ocular lesions such as choroidal nevus, or exposure to ultraviolet radiation.
In any case, the presence of these factors does not necessarily imply that a tumor will form, but it can justify more frequent ophthalmological check-ups.
Blurred vision and other warning symptoms
A relevant characteristic of ocular melanoma is that it develops in an area of the eye that is not externally visible, so it is advisable to be aware of the signs it can cause. These include blurred vision or loss of visual acuity, flashes of light, the appearance of 'floaters', perception of shadows or changes in the visual field, and, in some patients, visible modifications in the iris when the lesion is located in that region.
"Sometimes the patient consults for an unspecific symptom and we find the tumor, other times we detect it during a check-up. Therefore, if a striking visual change is noticed, it is advisable to get it checked, and if there are no symptoms but certain risk factors exist, photographic follow-ups and those using OCT and ultrasound are also performed, because the absence of discomfort does not guarantee that everything is fine," he added.
Diagnosis is supported by a complete ophthalmological examination and, depending on each situation, by complementary tests such as ocular ultrasound, optical coherence tomography, and other imaging techniques that allow for the assessment of the size, location, and characteristics of the lesion. This information is "key" to deciding the therapeutic plan.
Depending on each case, treatment may include localized plaque radiotherapy, other radiotherapeutic modalities when indicated, or surgical interventions in certain patients. Furthermore, since uveal melanoma carries a risk of dissemination, close monitoring is essential and, when appropriate, coordination with other specialists to monitor the evolution of the disease.
"Today we can treat many ocular melanomas trying to preserve the eye and, when possible, vision, but equally important is the subsequent follow-up. Control does not end with local treatment; it requires vigilance and a multidisciplinary approach when appropriate. Fortunately, research continues, and today there are specific centers that are delving deeper into determining the immunology and metabolism of the tumor to achieve new treatments that allow for better control of the process," concluded Álvaro Fernández-Vega.