Eye Cancer Treatments: Uveal Melanoma, Retinoblastoma, Conjunctival Tumors — Options & Multidisciplinary Care

Primary intraocular cancers are rare. Treatment is highly specialized, depending on type, size, location, laterality, vision potential, metastasis risk, and patient factors. Management requires ocular oncology multidisciplinary teams.

Main Types & Standard Treatments

1. Uveal Melanoma (Most Common Primary Intraocular Cancer in Adults)

• Sites: Choroidal (90%), ciliary body, iris.
• Radiation (primary for most):
  • Plaque brachytherapy (I-125, Ru-106, Pd-103) — gold standard for small/medium tumors.
  • Proton beam, Gamma Knife, CyberKnife — selected cases.
• Surgery: Local resection (small, anterior); enucleation (large, advanced, blind painful eye).
• Adjuvant: None proven; clinical trials for high-risk genetics (monosomy 3, BAP1).
• Metastasis surveillance: Liver MRI/US q6mo (hematogenous spread; 50% at 10–15 yrs).

2. Retinoblastoma (Most Common Childhood Eye Cancer; Median Age 2)

• Genetic: RB1 mutation (heritable 40%, sporadic 60%).
• Grouping (ICRB A–E): Guides globe salvage vs. enucleation.
• Globe-salvage therapies:
  • Intravitreal chemo (melphalan, topotecan) — for vitreous seeds.
  • Subtenon/intra-arterial chemo (melphalan) — high local concentration.
  • Laser (thermotherapy, photocoagulation) — small tumors.
  • Cryotherapy — peripheral small tumors.
  • External beam radiation (last resort — second cancer risk).
• Enucleation: Advanced (Group D/E), failed salvage, optic nerve invasion.
• Systemic chemo: Extraocular spread, high-risk pathology post-enucleation.

3. Conjunctival Melanoma / Squamous Cell Carcinoma / Lymphoma

• Surface tumors: wide local excision + adjuvant (cryo, topical chemo — interferon, 5-FU, mitomycin C; radiation).
• Lymphoma: radiation ± systemic chemo/immunotherapy (often systemic disease).

Multidisciplinary Team

• Ocular oncologist, radiation oncologist, medical oncologist, genetic counselor, pathologist, radiologist, nurse navigator.

Vision & Quality of Life

• Radiation complications: radiation retinopathy/optic neuropathy, cataract, neovascular glaucoma.
• Vision preservation possible for many small/medium tumors.
• Psychosocial support critical.

Early referral to ocular oncology center optimizes globe/vision/life outcomes. No "one size fits all" — treatment is personalized.