Eye cancer in adults

Uveal melanoma can cause:

• Flashes of light
• Loss of part of the visual field (for example a shadow or missing area in your side vision)

In many cases, there are no symptoms, and the tumor is discovered during a routine eye examination.

Conjunctival melanoma and conjunctival squamous cell carcinoma 

Conjunctival melanoma and conjunctival squamous cell carcinoma usually does not cause symptoms other than a growing lump on the eye or under the eyelid. It is usually brown or pink.

If uveal melanoma is suspected, an ophthalmologist (eye doctor) examines the eye carefully to make a diagnosis. The examination usually includes:

• A detailed examination of the eye and the back of the eye (fundus) 
• Ultrasound 
• OCT (optical coherence tomography) 
• Widefield images of the back of the eye 

Conjunctival melanoma or squamous cell carcinoma is diagnosed a careful examination and imaging, followed by surgically removing the suspicious area (surgical excision) under local or general anesthesia. The tissue is then examined in a laboratory to confirm the diagnosis.

Uveal melanoma 

The most common treatment for uveal melanoma is plaque radiotherapy (a small radioactive disc placed on the eye). If the tumor is too large, or if it surrounds the optic nerve, the eye may need to be surgically removed.

Conjunctival melanoma or squamous cell carcinoma

After surgical removal of the tumor, we usually offer plaque radiotherapy to reduce the risk that the tumor returns. We may also treat with chemotherapy eye drops according to a specific schedule.

Plaque radiotherapy 

In plaque radiotherapy, a small radioactive plaque (a thin metal disc) is sewn onto the surface of the eye during an operation under general anesthesia. The plaque contains a radioactive substance (usually ruthenium‑106 or iodine‑125).

• The plaque stays on the eye for a few days.
• The exact time varies depending on the thickness of the tumor and the strength of the plaque, so that the correct dose of radiation reaches the whole tumor.

The plaque is then removed in a second short operation, usually also under general anesthesia, depending on where the plaque is placed.

Enucleation – removing an eye 

Sometimes the eye needs to be surgically removed. This operation is called enucleation and is performed under general anesthesia.

To fill the eye socket after the eye has been removed, we place an implant inside the socket.

After healing, the inside of the socket looks similar to the inside of the lip. The straight eye muscles are attached to the implant so that the future prosthetic eye can move a little and look more natural.

Right after the surgery, a pressure bandage is placed over the eyelids. It usually remains in place for about 2 days. After the bandage is removed, it is common to have some bruising and swelling, and the eyelid is often closed.

After about 6 weeks, when the socket has healed, an ocularist (a specialist who makes artificial eyes) creates a prosthetic eye that closely matches the patient’s remaining eye in color and appearance.

Excenteration – removing all tissue inside the orbit

Rarely, conjunctival melanoma or squamous cell carcinoma is so widely spread in the conjunctiva that exenteration is needed. Exenteration means that all the tissue in the orbit is surgically removed. Enucleation is not possible, since the conjunctiva is needed to close the socket. Exenteration is performed by our oculoplastics team at St Erik Eye hospital.