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A malignant choroidal melanoma (also called "malignant uveal
melanoma" in technical terms) is by definition a malignant tumor that
develops directly in the eye. It arises from the pigmented cells in the
choroid. It is referred to as malignant, because it can also form
metastases, i.e. daughter tumors, in other parts of the body or grow from the
eye into the surrounding tissue. It is true that not all choroidal
melanomas are malignant in the same way. However, because malignant
choroidal melanomas can be life-threatening, you should make an appointment
with your doctor as soon as possible if you suspect this disease.
While in children the retinoblastoma is the most common eye cancer- or is a malignant type of eye tumor, the
choroidal melanoma occurs most frequently in adults. According to the
German Cancer Society, there are five to six new cases per 1,000,000
inhabitants every year, so the frequency of choroidal melanoma is 400 to 500
new cases across Germany. Most of these melanomas of the uvea, i.e. the
middle skin of the eye, start from the choroid, which is located between the
dermis and iris of the eye. Another five percent of choroidal melanomas
arise in the iris and ten percent in the ciliary body from which the lens is
attached. Choroidal melanomas almost always only occur on one side.
According to statistics, such a tumor in the eye develops in
women on average at 59 years of age, in men at 66 years. Even younger
people are not safe from such an eye ulcer: According to the “Guideline for
Adolescents and Young Adults” of the German and Austrian Societies for
Hematology & Medical Oncology, melanoma is the most common malignant tumor
in women between 20 and 30 years of age, and the second most common malignant
tumor in men.
According to a report by the Berlin Charité, the mortality rate for choroidal
melanoma diseases is an average of four to five percent in the first five
years. Symptoms and therapy depend on the type of ocular melanoma.
This
is what a choroidal melanoma looks like
A
choroidal melanoma is often discovered only by chance because it cannot be seen
from the outside and often does not cause any symptoms for a long time. Only
at an advanced stage does a choroidal melanoma appear as a rounded protrusion
with an irregular surface. The tumor can, but does not have to, be darkly
speckled (pigmented). Retinal detachment is also characteristic of uveal
melanoma.
Causes and Risks: How a choroidal melanoma
develops
In
a choroidal melanoma, the pigment cells of the choroid proliferate unchecked. According
to the current scientific status, the causes of a choroidal melanoma have not
yet been fully clarified. It is believed that UV radiation, among other
things, plays a role in its development. People with ocular melanocytosis
(increased occurrence of pigment cells in the eye), with a genetic
predisposition in the form of mutations (GNAQ / GNA11 genes) or with dysplastic
nevi (clinically noticeable moles / moles in the eye) are also considered to be
more at risk for this cancer.
A
choroidal nevus, i.e. a congenital benign tumor inside the eye, can also
develop into a choroidal melanoma.
According to the specialist association for diagnosis and treatment of
hematological and oncological diseases, the risk of developing uveal melanoma
can increase due to the following factors, among others:
Genetic / constitutional factors
- UV radiation
- Venous and dysplastic nevi
- familial or genetic predisposition
Acquired / Toxic Factors
- UV radiation (especially in
children and adolescents) • Melanocytic nevi (benign malformation of the
pigment cells)
- Immunosuppression
- Childhood cancer with radiation or chemotherapy
When is there a risk of metastases?
A
choroidal melanoma does not necessarily have to spread. According to the
Berlin Charité, however, there are various risk factors that make the formation
of metastases more likely. These include, for example, clinical aspects
such as the tumor location, size and delimitation as well as the histology of
the choroidal melanoma, for example whether there are vascular loops and
certain genetic factors.
Since the so-called monosomy 3 (i.e. chromosome 3 is only present once instead
of twice) in choroidal melanoma is particularly meaningful for a prognosis, the
doctor can check the chromosome status and thus the risk group of a patient in
order to make a diagnosis. To do this, he takes tissue and examines it.
FOCUS-GESUNDHEIT
05/18
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Diagnostics: This is how a
choroidal melanoma can be diagnosed
Often
the ophthalmologist discovers a choroidal melanoma more or less by chance
during a (routine) examination. In some cases, those affected notice that
something is wrong themselves, for example because the visual performance of
the affected eye deteriorates or the eyes flicker.
If a choroidal melanoma is suspected, the ophthalmologist first
examines the inside of the eye using an ophthalmoscope. It is alsoo
possible to make a diagnosis using ultrasound and magnetic resonance imaging ( MRI ).
Ophthalmoscopy
The
doctor examines the eye using something called an indirect ophthalmoscope. He
either wears this ophthalmoscope on his head, as glasses or it is attached to
the slit lamp. A magnifying glass that the doctor holds in front of the
eye reveals the fundus and thus the typical signs of a tumor.
Ultrasonic
According to the Charité Berlin, the ultrasound
examination ( sonography ) is an
important method to determine a choroidal melanoma. The doctor places a
small ultrasound head on the affected eye and directs a sound beam directly
onto the tumor. The reflection of the beam records the shape of the eye
ulcer as well as its size.
OCT
Optical
coherence tomography (OCT) is painless and non-contact. The
ophthalmologist scans the retina and choroid with a laser.
Fluorescence angiography
In
fluorescence angiography, or FAG for short, the doctor injects a dye into a
patient's arm vein. About 20 seconds later, it reaches the blood vessels
in the eye via the bloodstream, where it makes the local blood flow and the
distribution of the blood vessels visible. The doctor takes pictures for
the evaluation, which he can use to determine typical symptoms of choroidal melanoma.