Understanding Choroidal Melanoma: The Basics You Need to Know

Attention all medical professionals! Are you familiar with choroidal melanoma? This rare but dangerous eye cancer can be difficult to diagnose and treat, making it essential for healthcare providers to stay informed about its basics. Whether you're a seasoned ophthalmologist or a general practitioner looking to expand your knowledge, this post is for you. In this article, we'll cover everything from the symptoms and risk factors of choroidal melanoma to the latest treatment options available. 

What is choroidal melanoma?

Choroidal melanoma is a type of cancer that develops in the choroid, which is the layer of blood vessels and connective tissue between the retina and sclera (the white part of the eye). This type of cancer is relatively rare, accounting for only about 5% of all melanomas and 2% of all cancers of the eye. While choroidal melanoma can occur in people of any age, it is most commonly diagnosed in adults over the age of 50. The exact cause of choroidal melanoma is unknown, but it is thought to be associated with exposure to ultraviolet (UV) light. Symptoms of choroidal melanoma may include: Blurry or distorted vision, A dark spot on the retina that appears suddenly, Flashes or floaters in vision, increased pressure in eye. If left untreated, choroidal melanoma can grow and spread to other parts of the body, including the liver, lungs, and brain. While treatment options are available, they are often associated with significant side effects. 

How does choroidal melanoma develop?

The vast majority of choroidal melanomas are slow-growing and non-invasive. However, some types of choroidal melanoma can be aggressive and invasive, spreading to other parts of the body. There are several theories about how choroidal melanoma develops, but the exact cause is unknown. It is believed that choroidal melanoma may develop from abnormal cells in the choroid (melanocytes) that grow out of control. Choroidal melanoma may also be associated with exposure to ultraviolet (UV) light, as this can damage DNA and lead to abnormal cell growth.

Who is at risk for developing choroidal melanoma?

It is the most common primary cancer of the eye in adults and can occur at any age, but is most often diagnosed in people over 50. Though it is relatively rare, with an incidence of about 6 per million people per year, it is important to be aware of the risk factors for developing this condition. The most important risk factor for developing choroidal melanoma is having light-colored eyes. People with blue or green eyes are at a higher risk than those with dark brown eyes. Other risk factors include fair skin, a history of sun exposure and excessive UV exposure, a family history of melanoma, and certain genetic conditions such as dysplastic nevi syndrome. They will be able to monitor eyes for any changes that could indicate the development of choroidal melanoma. 

What are the symptoms of choroidal melanoma?

The first symptom of choroidal melanoma is usually a painless dark spot or shadow on the eye that is different from floaters, which are small specks or lines that drift across vision. Other symptoms of choroidal melanoma can include: Blurry vision, A change in the shape of pupil, Eye pain, Flashes of light in peripheral vision, Loss of central vision in one eye.

How is choroidal melanoma diagnosed?

Choroidal melanoma is usually diagnosed through a combination of medical tests. These may include: A physical examination of the eye, Imaging tests, such as ultrasound, CT scan, or MRI, Biopsy of the tumor. During a physical examination, the doctor will look at the eye with a special instrument called an ophthalmoscope. This allows them to see inside the eye and check for any abnormal growths. Imaging tests can help to confirm the diagnosis and assess the size and location of the tumor. An ultrasound uses sound waves to create images of the inside of the eye. A CT scan or MRI can also be used to produce detailed images. A biopsy involves taking a small sample of tissue from the tumor for laboratory analysis. 

How is choroidal melanoma treated?

Choroidal melanoma is most often treated with surgery. The goal of surgery is to remove the tumor while preserving as much normal tissue as possible. There are several types of surgical procedures that can be used to treat choroidal melanoma, and the type of surgery that is right for patients will depend on the size and location of tumor. For small tumors, a procedure called focal laser treatment may be an option. This involves using a high-energy laser to destroy the cancer cells while sparing the surrounding healthy tissue. Focal laser treatment is usually done on an outpatient basis, and it does not require general anesthesia. For larger tumors, a procedure called transpupillary thermotherapy (TTT) may be an option. TTT uses heat to destroy the cancer cells while sparing the surrounding healthy tissue. TTT is usually done on an outpatient basis, and it does not require general anesthesia. For larger tumors that are located near the center of the eye, a procedure called plaque brachytherapy may be an option. Plaque brachytherapy involves placing a small radioactive plate next to the tumor. The plate delivers a high dose of radiation directly to the cancer cells, while sparing the surrounding healthy tissue. Plaque brachytherapy is usually done on an outpatient basis, and it does not require general anesthesia. In some cases, radiation therapy may be used instead of or in addition to surgery. 

What are the outcomes of treatment for choroidal melanoma?

Treatment for choroidal melanoma generally has one goal: to remove as much of the tumor as possible while preserving eyesight. There are several ways to treat choroidal melanoma, and the approach used will depend on factors such as the size and location of the tumor, as well as whether it has spread beyond the eye. Surgery is usually the first treatment for choroidal melanoma. The type of surgery performed will depend on the size and location of the tumor. Small tumors may be treated with a procedure called transpupillary thermotherapy (TTT), which uses heat to destroy cancer cells. Larger tumors may require an operation to remove all or part of the eye (enucleation). In some cases, surgery may be done to remove only the part of the eye containing the tumor (local resection). For very large tumors, surgery may be combined with radiation therapy. If surgery is not an option or if there is evidence that cancer cells have spread outside of the eye, radiation therapy may be used. This can be done with a device placed outside of the body (external beam radiation therapy) or with radioactive material placed directly into or near the tumor (brachytherapy).

Conclusion

In conclusion, choroidal melanoma is a rare but serious eye cancer and medical professionals should be well informed of its signs and symptoms. Early diagnosis of choroidal melanoma is essential to ensure the best possible outcome for affected patients; however, due to the difficulty in accurately diagnosing this condition it can often be overlooked or misdiagnosed. By understanding the basics of choroidal melanoma, medical professionals are able to provide their patients with the necessary care and support required for successful treatment.

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