Understanding Melanoma: A Deeper Look

Melanoma, a serious type of skin cancer, has some clear warning signs.

New moles or changes in existing ones are key indicators of this illness, which affects over 200,000 Americans annually, alongside rough patches and shifts in skin color.

While cancerous lesions can appear on any skin surface, experts caution that melanoma can also emerge in unexpected places, like the eyes.

Melanoma often manifests on eyelids, which are vulnerable to harmful ultraviolet (UV) rays. If untreated, these cancers could invade the inner layers of the eye and even the brain, complicating treatment options significantly.

Strikingly, melanoma may even originate in areas that lack skin, such as within the eye itself—this variant is known as ocular melanoma. It encompasses types like uveal melanoma and conjunctival melanoma.

Interestingly, skin and eyes share the same cells, called melanocytes, responsible for producing melanin—the pigment that colors skin, hair, and eyes. Damage or mutations in these melanocytes can lead to melanoma.

Although sun exposure is a common cause of melanoma, uveal and conjunctival variants are not mainly linked to UV radiation. Individuals with lighter eye colors or certain pre-existing eye conditions might be at a higher risk.

As melanoma cases—and skin cancer overall—continue to escalate in the U.S., eye care professionals emphasize the importance of regular eye exams every one to two years. These checks can help catch any potential cancerous changes. Signs to watch for include subtle issues like blurred vision, spots, or irritation around the eye.

Dr. Jacqueline Bowen, an eye doctor and president of the American Optometric Association, mentioned that skin cancer can present in various forms around the eye. Some instances begin right there, while others might spread from elsewhere in the body.

Currently, around 1 million U.S. adults are living with melanoma, the most lethal skin cancer type. This year alone, approximately 212,000 new cases are expected, with a mortality rate of about two people per 100,000, translating to roughly 8,000 deaths annually.

Melanoma rates have surged in the last three decades. Data from the American Academy of Dermatology shows that diagnoses doubled from 1982 to 2011, followed by a 31.5 percent increase from 2011 to 2019.

For women over 50, melanoma rates have crept up by three percent annually, while men under 50 have noticed a one percent yearly decrease. Rates for women under 50 and men over 50 have remained relatively stable.

In the realm of ocular melanoma, there are uveal and conjunctival types. Typically, there are no symptoms in the early stages of ocular melanomas; however, as they progress, patients might notice blurry vision, floaters, or altered pupil shapes. The exact causes of ocular melanoma remain uncertain, but lighter eye and skin colors may increase susceptibility. The influence of UV light in this context is not well understood.

Each year, about 2,000 new cases of ocular melanoma are reported in the U.S., according to the Melanoma Research Foundation. Conversely, conjunctival melanoma is extremely rare, with around 130 cases annually in the U.S.—less than one in a million worldwide. Symptoms can include eye irritation, redness, or a feeling of something lodged in the eye. As it advances, it could lead to blurry vision or pupil changes.

Uveal melanoma, the most common type of eye cancer, arises in the middle layer of the eye known as the uvea. As with other eye melanomas, the causes are not fully understood, and exposure to UV light is not believed to play a significant role.

Dr. Bowen emphasized that many serious eye cancers, especially uveal melanoma, often don’t cause pain or visual changes in their early or even mid-stages. Since the retina is connected to the brain, undetected cancer can find a pathway to spread. This makes routine eye exams critical, even without any symptoms. During these examinations, optometrists use specialized microscopes to detect early or precancerous lesions.

Regular eye exams often catch cancers before symptoms develop, significantly enhancing treatment outcomes.

While there are no definitive cures for ocular melanoma, treatment options include specialized laser therapies or plaque brachytherapy to target tumors. Though doctors refrain from deeming patients ‘cured,’ they can achieve a state called NED—no evidence of disease.

Bowen recommends that anyone noticing changes in their eyes or vision should consult an eye doctor as soon as possible, especially if symptoms persist or worsen over weeks.

She added that early detection is vital at any age, pointing out that rare but dangerous eye cancers, like retinoblastoma in children, might only be found during comprehensive eye exams.