Although rare, ocular (uveal) melanoma is the most common primary cancer of the eye in adults with an estimated 2,000 – 3,000 new cases in the United States each year. This type of melanoma develops in the pigmented cells in the iris, ciliary body, and/or choroid — tissues which are collectively referred to as the uvea. Ocular (uveal) melanoma occurs most often in those age 55 or older with with light skin and light eyes but can occur in all races and at any age.
Because the tumor can grow and spread rapidly to other parts of the body (metastasize), which can be fatal, early detection is critical. Most patients do not experience any symptoms, and cases are typically identified through a routine dilated eye exam.
Treatment of Ocular Melanoma
Currently, there is no cure for ocular (uveal) melanoma. The goal of treatment is to prevent the disease from metastasizing, and the most common approach is a form of radiation therapy called plaque brachytherapy. A small disc-shaped shield known as a plaque encases radioactive seeds on one side and is covered with a thin sheet of gold on the other. It is surgically attached to the outside surface of the eye, over the tumor. The gold protects the surrounding areas of the body from radiation damage. The plaque is left in place for several days, allowing the radiation to treat the tumor. Once complete, it is then removed, and no radioactive material remains on or within the patient.
The Importance of Genetic Analysis
In addition to plaque brachytherapy, genetic analysis of the tumor helps ocular melanoma physicians determine a patient’s specific risk for metastatic disease and create a customized schedule for ongoing screening and surveillance to detect any changes as early as possible. This genetic analysis is performed through a fine needle aspiration biopsy of the patient’s tumor at the time of plaque treatment.
Emerging Research on New Ocular Melanoma Treatment Options
Texas Retina Associates and Timothy Fuller, MD, are active members of the Collaborative Ocular Oncology Group, a network of most major ocular and medical oncology physicians in North America who meet regularly to pursue the latest research into ocular (uveal) melanoma.
Texas Retina Associates is also participating in a groundbreaking Phase II clinical trial, testing a potential new treatment for small choroidal (ocular) melanoma. Together with Aura Biosciences, we are investigating the safety and efficacy of AU-011, a light-activated viral nanoparticle. Texas Retina Associates was the first in the nation to begin enrolling in this new trial, and Principal Investigator Timothy Fuller, MD, was the first in the nation to treat a patient with AU-011 delivered via suprachoroidal injection.
Aura’s previous Phase Ib/II trial investigated delivery of the drug in the vitreous, or “gel” of the eye, similar to more traditional injection techniques, while the current Phase II trial is investigating what shows promise to be a more effective manner to target this type of melanoma. Following injection, the tumor is treated with a special ophthalmic laser to activate the viral nanoparticles to selectively destroy the tumor. All of this is done in an outpatient, office-based setting.
In the 1980s, brachytherapy revolutionized how ocular melanoma was treated. However, it unfortunately almost always comes with vision loss. With AU-011, we are investigating the potential to treat this deadly disease with less harmful effects on vision. AU-011 has been shown in prior studies to selectively destroy cancer membrane cells while sparing the overlying retina, a tissue essential for good vision.
Ocular Melanoma Care at Texas Retina Associates
Because it is such a rare disease, only a small number of doctors in the United States have the training necessary to properly treat ocular (uveal) melanoma. Texas Retina Associates is the most experienced center in North Texas to treat uveal melanoma and has been doing so for over 40 years. Pioneered by Dwain Fuller, MD, and his leadership in the pivotal Colloborative Ocular Melanoma Study (COMS), the work to battle this deadly disease continues. Texas Retina Associates is fortunate to have two physicians who currently treat uveal melanoma:
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Protect Your Eyes
Texas Retina Associates encourages everyone to have regular dilated eye exams with their optometrist or ophthalmologist to screen for suspicious lesions and ocular melanoma.