Screening for Ocular Melanoma

Cancer screening exams can help find cancer at its earliest stage, when the chances for successful treatment are greatest. These tests are usually done when the patient is healthy and has no specific symptoms.

The American Academy of Ophthalmology recommends a dilated eye examination by age 40 to detect ocular melanoma and other eye problems early.

Additionally, expert cancer researchers at the OSUCCC – James are working to develop tests that can detect and diagnose the disease as early as possible, leading to improved outcomes, faster responses and fewer side effects.

If you’ve been diagnosed with ocular melanoma, would like a second opinion or would like to speak with an ocular melanoma specialist, please call The James Line at 800-293-5066 or 614-293-5066 to make an appointment.

Ocular Melanoma Risk Factors

A cancer risk factor is anything that increases your risk of developing the disease. Risk factors for ocular melanoma include:

  • Being 70 years of age or older
  • Having fair skin, especially if the skin freckles and burns easily, does not tan or tans poorly
  • Having blue, green or other light-colored eyes
  • Being Caucasian
  • Having dysplastic nevus syndrome
  • Having a family member with ocular melanoma
  • Having a freckle in the eye
  • Having a dark area on the white part of the eye and eyelid (nevus of Ota)
  • Having a germline mutation in the BAP1 gene
  • Being an arc welder can also increase risk

(Source: National Cancer Institute)

Not everyone with risk factors will get ocular melanoma. But having certain risk factors may increase your risk of developing the disease. If you are at risk for developing ocular melanoma, talk to your doctor about tests to find out if you have early signs of the disease.

If you’ve been diagnosed with ocular melanoma, would like a second opinion or would like to speak with an ocular melanoma specialist, please call The James Line at 800-293-5066 or 614-293-5066 to make an appointment.

Diagnosing Ocular Melanoma

An accurate, complete diagnosis is essential for effectively treating ocular melanoma. Because there is no routine cancer, the OSUCCC – James’s world-renowned ocular melanoma specialists and sub-specialists reach across multiple disciplines and modes of treatment to offer patients the latest technologies, drug treatments and the most advanced procedures to understand ocular melanoma at the molecular and genetic levels – the levels that drive each patient’s specific kind of cancer.

The OSUCCC — James is home to world-renowned diagnostic experts in ocular melanoma cancers. In fact, our team includes experts who specialize in ocular melanomas – and only melanomas, 24/7 – studying, discovering and treating each kind, and developing and delivering leading-edge therapies.

These sub-specialists and super sub-specialists use the most accurate, advanced diagnostic testing and technology to analyze your cancer, enabling an entire team across multiple medical disciplines to determine the most effective, targeted treatment specifically for you.

If ocular melanoma is suspected, your OSUCCC – James specialists will conduct the following tests to form a diagnosis:

Physical Exam

During a physical exam, an OSUCCC – James specialist examines the body carefully for any signs of disease. The patient is asked about medical history, lifestyle, any past disease, treatments and family history.

Eye Exam with Dilated Pupil

An ophthalmologist (specialized eye doctor) uses medicated drops to dilate, or enlarge, the pupils in order to examine the eyes thoroughly. By enlarging the pupils, the doctor can analyze the retina and optic nerve for signs of disease.

Types of eye exams include:

  • Ophthalmoscopy. An eye specialist examines the inside of the back of the eye, especially the retina and optic nerve, using a small light and magnifying lens.
  • Slit-lamp biomicroscopy. An eye specialist examines the inside of the eye using a strong beam of light and a microscope.
  • Gonioscopy. An eye specialist examines the front part of the eye between the iris and cornea using a special instrument to determine if there is tumor in the area where fluid drains from the eye.

Ocular Photographs

Ocular photographs. Pictures of the inside of the eye are taken with a special camera to document the presence/absence, location, and size of an ocular tumor and monitor for changes in size over time. Multiple pictures in one eye may be required to show the tumor dimensions.

Widefield ocular photographs. Pictures taken with a special camera show a very wide field of view of the inside of the eye to show the whole tumor often with one photograph. It can help to monitor tumors that are harder to photograph due to their location.

Ultrasound Eye Exam

Ultrasound uses sound waves to create images of the eye for your OSUCCC – James ocular melanoma expert to view on a computer. Eye drops numb the eye and a small probe is placed gently on the eye’s surface to send and receive the sound waves.

High-Resolution Ultrasound Biomicroscopy

High-resolution ultrasound can create even more detailed images for your OSUCCC – James subspecialist to review on a monitor than a regular ultrasound. This imaging is important for ocular tumors located closer to the front of the eye.

Trans-Illumination of the Globe and Iris

A light is placed on the upper or lower eyelid to examine structures in the eye.

Angiography

This procedure enables the OSUCCC – James experts to evaluate a patient’s ocular blood vessels. The patient receives an injection of a small amount of dye, which highlights the blood. After the dye travels through blood vessels to the eye, a special camera takes pictures of the retina and choroid to detect areas of blockage or leaking.

Optical Coherence Tomography

This imaging test uses light waves to take cross-sectional images of the retina and choroid to monitor small tumors or to identify areas of swelling or fluid under the retina.

Biopsy

A piece of tissue or tumor is removed so that a specially trained OSUCCC – James pathologist can examine the cells under a microscope for signs cancer. The following tests may also be used to analyze the sample for genetic changes that give important information about the prognosis of an individual patient’s ocular melanoma:

  • Cytogenetic analysis: Sample cells are analyzed under a microscope to look for certain changes in chromosomes that are important in ocular melanoma.
  • Molecular genetic analysis: Sample cells are analyzed with molecular genetic techniques to detect certain changes in chromosomes important in ocular melanoma.
  • Gene expression profiling: Sample cells are analyzed for certain types of RNA, which is the nucleic acid made by cells, which relates to making proteins.

Tests Used to Stage Ocular Melanoma

If you are diagnosed with ocular melanoma, staging the tumor is just one of many ways your OSUCCC – James ocular melanoma experts can determine the amount and location of your cancer, as well as if it has spread, and it can help them choose the most effective, personalized treatment options for your particular cancer.

The following tests can be used to determine if ocular melanoma has spread to other areas of your body:

Blood Chemistry Analysis

A blood sample is checked to measure certain substances in the blood for signs of disease.

Liver Function Tests

A blood sample is analyzed for high amounts of certain substances released by the liver that can indicate that ocular melanoma has spread to the liver.

Ultrasound

Ultrasound uses sound waves and a computer to create images of organs such as the liver and can detect ocular melanoma that has spread to the liver at an earlier stage than liver function tests.

Chest X-Ray X-rays produce images of the tissues and organs inside the chest, especially the lungs to detect ocular melanoma.

CT Scan (Computed Tomography)

An X-ray test that produces detailed, cross-sectional images of your body and can detect ocular melanoma that has spread at an earlier stage than liver function tests and other blood tests.

MRI (Magnetic Resonance Imaging)

An MRI uses a high-powered magnet and radio waves to produce detailed images of the body. It can detect ocular melanoma that has spread at an earlier stage than liver function tests and some other imaging tests.  A special substance may be injected into a vein before the test, and that substance will collect around areas with cancer cells. A computer then translates the radio waves into a detailed picture to help the OSUCCC – James specialists determine if a tumor is present.

PET Scan (Positron Emission Tomography)

A PET scan uses a small amount of injected radioactive tracer mixed with glucose to identify cancer cells in the body. The PET scanner rotates around the patient’s body, and a special imaging camera displays images of these cells brighter than those of normal, healthy cells.

(Source: National Cancer Institute)

Staging Ocular Melanoma

If you are diagnosed with ocular melanoma, staging the tumor is just one of many ways your OSUCCC – James melanoma experts can determine the amount and location of your cancer, as well as if it has spread, and it can help them choose the most effective, personalized treatment options for your particular cancer.

The OSUCCC – James ocular melanoma specialists follow the American Joint Commission on Cancer’s staging protocols.

Though most ocular melanoma tumors are raised, some are flat. These tumors grow widely across the uvea.

The OSUCCC – James experts use two staging systems for ocular melanoma, depending on where the cancer first formed in the eye: the iris or the ciliary body and choroid.

If ocular melanoma spreads outside the eyeball into the surrounding tissues it is called extraocular extension.

The following stages are used for ocular melanoma of the iris:

Stage I

  • The tumor is in the iris only and is one fourth or less of the size of the iris.

Stage II

  • Stage II is divided into stages IIA and IIB.
    • In stage IIA, the tumor:
      • Is in the iris only and is more than one fourth the size of the iris; or
      • Is in the iris only and has caused glaucoma; or
      • Has spread next to and/or into the ciliary body, choroid or both. The tumor has causedglaucoma.
    • In stage IIB, the tumor:
      • Has spread next to and/or into the ciliary body, choroid or both, and
      • Has also spread into the sclera.
      • The tumor has caused glaucoma.

Stage III

  • Stage III is divided into stages IIIA and IIIB.
    • In stage IIIA, the tumor:
      • Has spread through the sclera to the outside of the eyeball.
      • The part of the tumor outside the eyeball is not more than 5 millimeters thick.
    • In stage IIIB, the tumor
      • Has spread through the sclera to the outside of the eyeball.
      • The part of the tumor outside the eyeball is more than 5 millimeters thick.

Stage IV

  • The tumor may be any size and has spread:
    • To nearby lymph nodes; or
    • To other parts of the body, such as the liver, lung or bone, or to areas under the skin.

Ocular melanoma of the ciliary body and choroid is grouped into four size categories. The category depends on how wide and thick the tumor is. Category 1 tumors are the smallest and category 4 tumors are the biggest.

Category 1

  • The tumor is not more than 12 millimeters wide and not more than 3 millimeters thick; or
  • The tumor is not more than 9 millimeters wide and 3.1 to 6 millimeters thick.

Category 2

  • The tumor is 12.1 to 18 millimeters wide and not more than 3 millimeters thick; or
  • The tumor is 9.1 to 15 millimeters wide and 3.1 to 6 millimeters thick; or
  • The tumor is not more than 12 millimeters wide and 6.1 to 9 millimeters thick.

Category 3

  • The tumor is 15.1 to 18 millimeters wide and 3.1 to 6 millimeters thick; or
  • The tumor is 12.1 to 18 millimeters wide and 6.1 to 9 millimeters thick; or
  • The tumor is 3.1 to 18 millimeters wide and 9.1 to 12 millimeters thick; or
  • The tumor is 9.1 to 15 millimeters wide and 12.1 to 15 millimeters thick.

Category 4

  • The tumor is more than 18 millimeters wide and may be any thickness; or
  • The tumor is 15.1 to 18 millimeters wide and more than 12 millimeters thick; or
  • The tumor is 12.1 to 15 millimeters wide and more than 15 millimeters thick.

The following stages are used for ocular melanoma of the ciliary body and choroid:

Stage I

  • The tumor is size category 1 and is in the choroid only.

Stage II

  • Stage II is divided into stages IIA and IIB.
    • In stage IIA, the tumor:
      • Is size category 1 and has spread to the ciliary body; or
      • Is size category 1 and has spread through the sclera to the outside of the eyeball.
      • The part of the tumor outside the eyeball is not more than 5 millimeters thick.
      • The tumor may have spread to the ciliary body; or
      • Is size category 2 and is in the choroid only.
    • In stage IIB, the tumor:
      • Is size category 2 and has spread to the ciliary body; or
      • Is size category 3 and is in the choroid only.

Stage III

  • Stage III is divided into stages IIIA, IIIB, and IIIC.
    • In stage IIIA, the tumor:
      • Is size category 2 and has spread through the sclera to the outside of the eyeball.
      • The part of the tumor outside the eyeball is not more than 5 millimeters thick.
      • The tumor may have spread to the ciliary body; or
      • Is size category 3 and has spread to the ciliary body; or
      • Is size category 3 and has spread through the sclera to the outside of the eyeball.
      • The part of the tumor outside the eyeball is not more than 5 millimeters thick.
      • The tumor has not spread to the ciliary body; or
      • Is size category 4 and is in the choroid only.
    • In stage IIIB, the tumor:
      • Is size category 3 and has spread through the sclera to the outside of the eyeball.
      • The part of the tumor outside the eyeball is not more than 5 millimeters thick.
      • The tumor has spread to the ciliary body; or
      • Is size category 4 and has spread to the ciliary body; or
      • Is size category 4 and has spread through the sclera to the outside of the eyeball.
      • The part of the tumor outside the eyeball is not more than 5 millimeters thick.
      • The tumor has not spread to the ciliary body.
    • In stage IIIC, the tumor:
      • Is size category 4 and has spread through the sclera to the outside of the eyeball.
      • The part of the tumor outside the eyeball is not more than 5 millimeters thick.
      • The tumor has spread to the ciliary body; or
      • May be any size and has spread through the sclera to the outside of the eyeball.
      • The part of the tumor outside the eyeball is more than 5 millimeters thick.
      • The tumor has not spread to the ciliary body.

Stage IV

  • The tumor may be any size and has spread:
    • To nearby lymph nodes; or
    • To other parts of the body, such as the liver, lung or bone, or to areas under the skin.

(Source: National Cancer Institute)

If you’ve been diagnosed with ocular melanoma, would like a second opinion or would like to speak with an ocular melanoma specialist, please call The James Line at 800-293-5066 or 614-293-5066 to make an appointment.

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