When to Suspect and How to Diagnose Uveal Melanoma (Podcast)

Biopsy is usually unnecessary for this rare eye cancer

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Approximately 2,000 to 2,500 new cases of uveal melanoma are reported in the U.S. each year, says Arun Singh, MD, Director of Ophthalmic Oncology at Cleveland Clinic Cole Eye Institute. Dr. Singh treats about 150 of them.

“Diagnosis of uveal melanoma is predominantly clinical, based on examination and imaging,” he says. “Once we dilate the pupil, we can see a tumor directly. Uveal melanoma has characteristic features, so we can diagnose it with greater than 99% accuracy, typically without a biopsy.”

In a recent episode of Cleveland Clinic’s Cancer Advances podcast, Dr. Singh explains more about the diagnosis and treatment of this rare eye cancer. He briefly discusses:

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  • Prevalence compared to cutaneous melanoma
  • Symptoms of uveal melanoma — and when to see an oncologist
  • Brachytherapy and other treatment options, including clinical trials
  • Predicting and managing metastases
  • When to consider endoresection

Click the podcast player above to listen to the episode now, or read on for a short edited excerpt. Check out more Cancer Advances episodes at clevelandclinic.org/podcasts/cancer-advances or wherever you get your podcasts.

Excerpt from the podcast

Dr. Singh:  Treatment depends on the size and the vision potential of the eye. First of all, you consider if it is really melanoma or just a big freckle inside the eye. For cases that are borderline, we’ll observe them. But once the diagnosis is made, the most common treatment is really a radiation treatment. It’s a brachytherapy, where we take a radiation implant and stitch it to the eye, right at the base of the tumor, so the radiation is focused onto the tumor with the least collateral damage.

If a tumor is large and if there is no vision potential in the eye, then we talk about removal of the eye. Tumors that are located more towards the front of the eye, such as in the iris or ciliary body, can be resected.

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Podcast host Dale Shepard, MD, PhD:  What do you see as the drawbacks of our current therapies? Where do we fall short and where do we need to make progress?

Dr. Singh:  Radiation for uveal melanoma has been around for almost 100 years. That’s because we have control rates of 95-99%. Our local control rate is very, very high. So it’s very hard to come up with new treatments that will surpass something that’s highly effective.

Dr. Shepard:  I’m just going to jump in and say that I’m exceedingly jealous.

Dr. Singh:  Yeah. In all of radiation oncology, choroidal melanoma or uveal melanoma radiation has the highest control rate, 99%. In our series here at Cleveland Clinic that we published, our control rate overall is 95.6% ⁠— smaller tumors, 99% over the last 15 years. Of course, there is collateral damage from radiation, radiation retinopathy, which affects vision. And there is a trial starting later this year, a multicenter trial, to figure out treatment of radiation retinopathy, how to mitigate it. The Cole Eye Institute is taking the lead on it because we are going to be the main center driving the trial.