Dr. Aditya Bansal
University of Kentucky
When you think of cancer, eye cancer may not be the first thing that comes to mind. However, ocular melanoma — a rare but serious disease — deserves attention. It is the most common primary eye cancer in adults, and early detection can significantly improve outcomes.
What Is Ocular Melanoma?
Ocular melanoma (also called uveal melanoma) develops from melanocytes, the cells that produce pigment in the eye. Although it accounts for only about 5% of all melanoma cases, it is the leading cancer that originates inside the eyeball in adults.
The uvea—the eye’s middle layer—includes the iris (the colored part), the ciliary body (involved in focusing), and the choroid (a layer rich in blood vessels). Most cases begin in the choroid.
How Common Is It?
In the United States, ocular melanoma is diagnosed in about 5 out of every 1 million people annually, translating to roughly 2,000 new cases each year. Though rare, the disease requires vigilance because of its potential severity.
Warning Signs
Early-stage ocular melanoma often causes no symptoms and may only be detected during a routine eye exam. As the tumor grows, you might notice:
• Blurry vision or loss of side vision
• Flashes of light
• Floaters (spots drifting across vision)
• A growing dark spot on the iris
• A change in pupil shape
These signs don’t always mean cancer, but any new visual change should be checked promptly.
Risk Factors
Factors that may increase risk include:
•
Age
: More common after age 60
•
Light eye color
: Blue, green, or gray eyes carry higher risk
•
Family history
: Rarely, it can run in families
Diagnosis, Treatment, and Prognosis
If ocular melanoma is suspected, your doctor will refer you to an eye cancer specialist. Diagnostic tests typically include a detailed eye exam and imaging, such as ultrasound.
Treatment options vary by tumor size and spread, and may include:
• Radiation therapy
• Surgical removal
• Laser therapy
• Targeted or immunotherapy (if spread is detected)
The prognosis for small, localized tumors is generally good, with high rates of vision preservation and local tumor control. However, about 50% of patients with ocular melanoma may develop metastasis—most commonly to the liver—which can complicate outcomes. Close follow-up is essential.
Awareness Matters
Though rare, ocular melanoma can be vision- and life-threatening. Regular eye exams, especially for people over 60 or those with light-colored eyes, are key to catching it early.
Dr. Aditya Bansal, M.D., is an ophthalmologist at the University of Kentucky Markey Cancer Center