Eye (Ophthalmic) Cancer

Ophthalmic cancers although uncommon, may arise from various eye and orbital structures. In general, they can be classified as eyelid tumors, conjunctival/corneal cancers, uveal cancers, retinal cancers, and orbital/adnexal cancers. The symptoms and clinical presentation depends upon the location of the tumor. In general, treatment involves surgery, radiation, and chemotherapy. In addition specialized procedures such as thermotherapy and brachytherapy are used for local ophthalmic treatment. In this section, we limit our discussion to general aspects of four representative ophthalmic cancers; sebaceous carcinoma of the eyelid, squamous cell carcinoma of the conjunctiva, uveal melanoma, and retinoblastoma.

Squamous Cell Carcinoma of the conjunctiva What is squamous cell carcinoma of the conjunctiva? Squamous cell carcinoma of the conjunctiva is a malignant tumor arising from the membranous lining of the eyeball and eyelids. Squamous cell carcinoma is considered within the clinical spectrum of ocular surface squamous neoplasia (OSSN) which includes all epithelial tumors affecting the conjunctiva and the cornea (Figure SCC). What are the symptoms? Unilateral red eye Eye irritation Conjunctival mass How is it diagnosed? Excisional or incisional biopsy What are the treatment options? Complete removal with supplemental cryotherapy (freezing of the tumor) Topical chemotherapy for extensive, diffuse, or recurrent involvement.

Uveal Melanoma What is uveal melanoma? Uveal melanoma is the most common primary malignant tumor inside the eye. It arises from uveal melanocytes, or the pigmented cells. Based on anatomic location it is of three types; iris melanoma, ciliary body melanoma, and choroidal melanoma (Figure UVMM ). What are the symptoms? Iris melanoma presents as an iris pigmented mass. Ciliary body melanoma can cause blurred vision. Loss of vision, flashing light sensation, exudative retinal detachment are some of the common presentations of a choroidal melanoma. How is it diagnosed? The diagnosis is essential clinical based on indirect ophthalmoscopy, angiographic studies and ultrasonographic pattern. The diagnostic accuracy with such techniques is 99% and therefore, biopsy is performed only in very atypical cases.

What are the treatment options?

The Collaborative Ocular Melanoma Study (COMS) divided choroidal melanoma according to size into small, medium, and large tumors based upon tumor diameter and height. Several factors are considered in selecting the appropriate therapy from the following list of options.

Small: Observation, thermotherapy (laser), surgical excision, brachytherapy.

Medium: Brachytherapy, surgical excision, enucleation (removal of the eyeball).

Large: Enucleation, brachytherapy.