Treatments for melanoma of the eye

The following are treatment options for melanoma of the eye, including uveal melanoma and conjunctival melanoma. These are types of intraocular melanoma. (Intraocular means “within the eyeball.”) Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. Radiation therapy is the main treatment for melanoma of the eye. Sometimes, radiation therapy can be given after surgery (this may be called adjuvant therapy) .

Brachytherapy (plaque therapy) is the most common type of radiation therapy used for eye cancer. A container shaped like a bottle cap (called a plaque) that contains small radioactive particles (called seeds) is placed on the surface of the eye over the tumour.

External radiation therapy is usually used for large tumours or if the cancer is close to the optic nerve. The radiation is delivered using a machine outside the body. Proton therapy or stereotactic radiosurgery are the techniques that may be used for melanoma of the eye.

Find out more about radiation therapy for eye cancer.

You may be offered surgery for melanoma of the eye. Whether you are offered surgery and what surgery you have depends on the size of the tumour and where it is in the eye.

If you have surgery to place a plaque for brachytherapy, no tissue is removed.

Surgical excision removes the tumour along with some normal tissue around it (called the surgical margin). It is used for small tumours.

Cryosurgery uses extreme cold to freeze and destroy cancer cells. It is used after radiation therapy or other surgery to kill any cancer cells that may have been left behind.

Transpupillary thermotherapy (TTT) is a type of laser surgery that uses heat from an infrared laser to destroy cancer cells. It can be used for small tumours.

An enucleation removes the eyeball and part of the optic nerve but leaves the eye socket and adnexal (accessory) structures in place. It is most often used for tumours that can’t be treated with radiation therapy or when cancer comes back in the eye after another treatment (called local recurrence) .

An orbital exenteration removes the eyeball and surrounding tissues and structures. It is typically only used when cancer has spread outside of the eye.

A liver resection removes part of the liver. It is sometimes used if melanoma of the eye spreads to the liver (called liver metastases) .

Find out more about surgery for eye cancer.

Immunotherapy helps to strengthen or restore the immune system’s ability to fight cancer. The following immunotherapy drugs may be offered for advanced or metastatic melanoma of the eye. They are used to relieve symptoms (called palliative therapy) and are given by a needle in a vein (intravenous, or IV).

• tebentafusp-tebn (Kimmtrak)
• pembrolizumab (Keytruda)
• nivolumab (Opdivo), with or without ipilimumab
• ipilimumab (Yervoy), with or without nivolumab

Sometimes the immunotherapy drug interferon alfa-2b (INF2b) is used to treat conjunctival melanoma. This drug is given as eyedrops.

Find out more about immunotherapy for eye cancer.

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer. Targeted therapy is sometimes offered for advanced or metastatic melanoma of the eye. It may also be used to try to shrink the tumour so it can be removed with surgery (called neoadjuvant therapy).

You may be given trametinib (Mekinist), with or without dabrafenib (Tafinlar), for metastatic melanoma of the eye. In some cases, targeted therapy drugs for melanoma skin cancer are also used.

Targeted therapy may also be used to treat vision problems caused by radiation therapy. You may have:

• bevacizumab (Avastin and biosimilars)
• ranibizumab (Lucentis and biosimilars)

Find out more about targeted therapy for eye cancer.

Chemotherapy uses drugs to destroy cancer cells.

You may be offered chemotherapy for conjunctival melanoma. It is given as eye drops (a form of topical chemotherapy). You may have the following drugs as topical chemotherapy:

• mitomycin C
• fluorouracil (also called 5-fluorouracil or 5-FU)

Chemotherapy can also be used to relieve symptoms of metastatic melanoma of the eye (called palliative therapy). It is usually a systemic therapy given through a needle into a vein (intravenous) or as a pill taken by mouth. If cancer has spread to the liver, chemotherapy may be given by chemoembolization.

The following chemotherapy drugs may be offered for metastatic melanoma of the eye:

• dacarbazine
• temozolomide
• paclitaxel, with or without carboplatin
• nab-paclitaxel
• melphalan

Find out more about chemotherapy for eye cancer.

You may be offered active surveillance for melanoma of the eye if you are not well enough to have other treatments or if the tumour is very small and not causing any symptoms. The goal of active surveillance is to help you keep a good quality of life while delaying other treatments that can cause side effects for as long as possible. Your healthcare team will use tests and exams to see if the eye cancer is growing or spreading. You will be offered other treatments if you develop symptoms or the cancer changes.

Find out more about active surveillance for eye cancer.

Talk to your doctor about clinical trials open to people with eye cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.