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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