Download Patient information – ocular oncology service

Patient information – ocular oncology service
Ocular melanoma
What is an ocular melanoma?
An ocular melanoma is the most common
type of eye tumour. It develops from cells
called melanocytes, which are found in
the uvea (the middle layer of tissue
around the eyeball that includes the
choroid, the ciliary body and the iris).
Ocular melanomas usually affect one eye
only.
What is the cause of an ocular
melanoma?
There is no known cause of ocular
melanoma, and it is not linked to skin
melanoma. It is a very rare form of cancer
affecting between only five and seven
people in every million each year. It is
Moorfields Eye Hospital NHS Foundation Trust
City Road, London EC1V 2PD
Phone: 020 7253 3411
www.moorfields.nhs.uk
more common in fair skinned, blue-eyed
people. The average age from which an
ocular melanoma develops is 55 years.
What are the symptoms of an ocular
melanoma?
For some people there may not be any
symptoms and the tumour is found during
a routine eye test. For others, it can cause
visual disturbances such as flashing lights
or a shadow.
How is the diagnosis made?
During your first visit to the ocular
oncology clinic at Moorfields, we will carry
out the following investigations:
 Visual acuity and dilation of both eyes
 Clinical examination by the consultant
 Colour photographs of the lesion will
normally be carried out
 Sometimes it is also necessary to
perform an intravenous angiogram –
this involves injection of one or two
dyes (fluorescein and/or indocyanine
green) and then photographs are taken
at timed intervals to look at tumour
circulation
 Ultrasound scan of the eye to
determine the size and location of the
tumour
Your eye doctor will discuss the results of
any investigations with you and confirm
the diagnosis.
What are the treatment options?
The appropriate treatment depends
largely on the size and location of the
melanoma, as explained below.
Enucleation (removal of the eye)
We usually only consider removal of the
eye if:
 Your tumour is relatively large, which
increases the risk of having a painful
blind eye following conventional
treatment
 You have other problems with your
general health
 You decide that removing your eye is a
better choice than other kinds of
treatment
Ruthenium plaque treatment
A plaque is surgically placed on the
surface of the eye to treat the tumour in
your eye. The plaque is made of a
radioactive isotope of ruthenium (a
chemical element). Plaques are available
Moorfields Eye Hospital NHS Foundation Trust
City Road, London EC1V 2PD
Phone: 020 7253 3411
www.moorfields.nhs.uk
in different sizes meaning the correct size
can be used for each patient.
Stereotactic radiosurgery
Stereotactic radiosurgery is a type of
radiation treatment that uses gamma rays.
Gamma rays are different from the x-rays
used in a standard x-ray in that they have
a much shorter wavelength. These gamma
rays are directed at the tumour in your eye.
Proton beam radiotherapy
Protons are hydrogen ions that are
accelerated to a high energy so that they
are able to penetrate tissue to a specific,
clearly defined depth and area. This
means they are very practical for treating
small areas of the eye. The treatment
works by sterilising the tumour cells so
that they can no longer reproduce. The
results can vary depending on the size of
the tumour, but for small lesions the
success rate is high. Larger lesions carry
a greater risk of complications.
Local resection (surgical removal of
the tumour)
Small melanomas near the front of the
inside of the eye can occasionally be
surgically removed under general
anaesthetic.
Iridectomy (surgical removal of iris
melanoma)
Small melanomas on the iris (the coloured
part of the eye) can occasionally be
surgically removed under a general
anaesthetic.
Photodynamic therapy
Photodynamic therapy involves the slow
injection of a drug, called visudyne
(verteporfin), through a vein in your arm.
Once the injection has been performed, a
low power laser is shone into the eye and
focused on the area being treated for just
over a minute to activate the visudyne.
Who decides what treatment I will
need?
The consultant in charge of your care,
together with the medical, nursing and
support team meet weekly to discuss
each patient’s diagnosis. They review the
results of each patient’s diagnostic tests
and discuss the best treatment options.
Once the best course of treatment has
been agreed by the team, this is
discussed with the patient.
Who can I speak to if I have any
questions?
The ocular oncology clinical nurse
specialists are available to answer any
questions and talk to you about your
treatment. You can contact:

Sinead Hanrahan
Phone: 07711 765 371
Moorfields Eye Hospital NHS Foundation Trust
City Road, London EC1V 2PD
Phone: 020 7253 3411
www.moorfields.nhs.uk
 Nana Gyasi -Twum
Phone: 07885 447 138
If they are not available to take your call,
please leave a message and they will call
you back as soon as possible.
Please note…
If you do require an operation this will be
carried out at St Bartholomew’s Hospital.
The medical and nursing team will explain
where you will receive your treatment
when they discuss your treatment with you.
Author: Victoria Cohen, consultant, ocular oncology
Revision number: 1
Approved: August 2015
Review date: August 2017
Our thanks to Sheffield Teaching
Hospitals NHS Foundation Trust, who
produced the original leaflet on which this
information is based.
Moorfields Eye Hospital NHS
Foundation Trust
City Road, London EC1V 2PD
Phone: 020 7253 3411
www.moorfields.nhs.uk
Moorfields Direct telephone helpline
Phone: 020 7566 2345
Monday to Friday, 9am–9pm
Information and advice on eye conditions
and treatments from experienced
ophthalmic-trained nurses.
Patient advice and liaison service
(PALS)
Phone: 020 7566 2324 or 020 7566 2325
Email: [email protected]
Moorfields’ PALS team provides
confidential advice and support to help
you with any concerns you may have
about the care we provide, guiding you
through the different services available at
Moorfields. The PALS team can also
advise you on how to make a complaint.
Moorfields Eye Hospital NHS Foundation Trust
City Road, London EC1V 2PD
Phone: 020 7253 3411
www.moorfields.nhs.uk