Watchful waiting/Active surveillance

Your doctor may recommend "watchful waiting" or "active surveillance" for small tumors of the iris or choroid. In patients with no symptoms, the benefits of treatment may not outweigh the side-effects. These patients will be monitored closely with eye exams. If the doctor detects any cancer progression, active treatment may be started.

Local resection

The doctor may recommend local resection surgery to treat smaller melanomas of the eye. The doctor will remove the melanoma and a small margin of healthy surrounding tissue. Local resections are most often used to remove melanomas of the iris, as these tumors are located at the front of the eye and are more accessible.

Enucleation

For larger, more advanced tumors, your doctor may need to remove your entire eye. If your eye is removed, your doctor will order a prosthetic (artificial) eye. The doctor will first insert an implant into your eye socket and attach it to your eye muscles. The doctor will then insert the prosthesis, which is painted to match your eye color. The implant allows the prosthesis to move normally.

Radiation Therapy

Radiation therapy is the use of high-energy particles to kill cancer cells. There are two forms of radiation therapy used for melanoma of the eye: brachytherapy and external beam therapy.

Brachytherapy

Brachytherapy is the placement of a radioactive device very close to a tumor. The device used for melanoma of the eye is commonly called a "plaque". The plaque has radioactive pellets attached to it. The plaque is usually made of gold, which helps prevent radiation damage to nearby healthy tissues. The plaque will be held in the eye with temporary stitches and healthy tissues. The plaque will be held in the eye with temporary stitches and left in place for three to seven days.

Proton Therapy

The alternative form of radiation therapy for melanoma of the eye is external beam therapy. This is usually delivered using a proton beam. Proton therapy can target tumors much more precisely and with higher amounts of radiation than conventional radiotherapy. Doctors can control the proton beam so that most of the radiation is deposited at the tumor site, and healthy tissues are spared as the beam moves through the body.

• Please see Understanding Proton Therapy to learn more.

Thermotherapy/Laser therapy

Thermotherapy uses heat to destroy cancer cells. Doctors may use a laser, ultrasound, microwaves, or infrared radiation to administer thermotherapy. In laser therapy, cancer cells are destroyed with intense beams of light. Another form of thermotherapy is photocoagulation, in which the doctor uses a laser to destroy the blood vessels that lead to the tumor, cutting off its supply of nutrients. These procedures may be used to treat small melanomas of the eye. Some doctors also recommend combining laser therapy with plaque radiotherapy to treat choroidal melanomas.

Clinical Trials

Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.

There are many new clinical trials available for melanoma of the eye. Your doctor may refer you to clinicaltrials.gov to learn more about these trials.