Type of Eye Cancer

eye cancer via lifespan.org

Hi I'm dr. Tara McConnell at the Department of Ophthalmology at UCLA and our topic today is going to be need us of the eye could this mean cancer

many people who know that they have a freckle of the iris or pigmented spot or know of an Edith inside the I have often wondered if this could be cancer or if this may become cancer

I'm hoping that today we may be able to answer some questions regarding why it's important

to be monitored at stein eye Institute we do see a lot of people with ocular melanoma even

diagnosed small and it's caught early the prognosis may be good it is also very reassuring to

know that your freckle or knee this is a benign condition I encourage you to ask questions via social media here and we'll do our best to answer afterwards so what is an Edith Anita is a

benign lesion condition of the eye and other terms that are used may be freckle a spot a lesion and all these things refer to a benign condition let's have a look at some examples so here is a

pigmented lesion of the choroid which is inside the eye you can see the dark pigmentation and you can also make out a few yellow spots on the surface these are drusen and suggest

chronicity the lesion has been there for a while here's another nevis that is elevated as

 opposed to flat and it also has the yellow spots or the drusen on the surface over here is a Nevis in the front of the eye of the iris and you could see that there is a little bit of

 pigmentation in the spot of concern finally we have a flat Nevis which is next to the optic nerve which is where the neural connections of the retina come in and help us see and this

lesion is flat and not causing any distortion of the inside of the eye these are all examples of anita's how do we discover ocular Nev I most of the time Nev I do not give a person any

 symptoms and they're found usually on a routine eye evaluation many times when we visit

the eye care provider there may be photographs performed of the eye and many times these

reveal unusual spots that get further evaluated anyone who has been to an eye care provider

may be offered to have pictures of the back of the eye and may be familiar with this sort of a

 setup and I think the reason we're seeing more of this is because this is a fairly straightforward examination for a patient to undergo the pupil does not need to be dilated and a picture like

this provides a significant amount of information of the inside of the eye here is an example of the spot that was found by such a photograph you can see the pigmentation that the arrow

photo diseasespictures.com

 is pointing to this is a Nevis this is another patient who had a pigmented spot again this is

one of those photographs that capture much of the back of the eye and it's important to

realize that this is actually not an Edith this is a melanoma so photographs taken to the back

of the eye are helpful for identifying things that are abnormal but they may not be helpful in

providing a diagnosis this particular patient was monitored for over a year before we saw them

 in diagnosed melanoma here's another example of a patient and you can see the tumor in the periphery here because of the slight distortion of coloration it doesn't appear pigmented in

fact it looks sort of yellow on this photo but this person had a photo taken about a year

before and was told she had something unusual in the eye and was told not to be concerned

however as time went on her lesion grew so this leads us to the question of could my Nevis

 actually be cancer oftentimes when someone says you have a freckle in your eye don't be

concerned the diagnosis is correct because as in our previous examples Anita's has very benign

characteristics that most eye care practitioners are able to distinguish however sometimes the diagnosis of a benign nevis may not be correct and the person may actually have a small

melanoma a person may also have a benign nevis in their eye which has been there for many

years but we still recommend that this be monitored because of benign freckle or spot of the eye can slowly change over time just like an unusual freckle on one skin can turn into a

melanoma what are the features of a lesion or a spot in the eye that has become a melanoma

or that may be worrisome for melanoma any nevis that is elevated or has some sort of

 measurable thickness by imaging tests must be monitored closely those Nev eye or freckles

are at a higher risk of turning into a melanoma over time any needeth that is associated with

some activity and by activity we often see fluid or leaking of the lesion when a lesion such as

 this has leakage occurring and we see fluid there is a very high risk that this may be turning into a melanoma so let's talk a little bit about small ocular melanoma or small choroidal

melanoma and this is a very controversial area and even amongst ophthalmic oncologists who

 see a lot of patients with melanoma and knee by because sometimes in borderline cases there

 is not absolute agreement on whether a spot may be benign or actually be a melanoma so

what is a small melanoma most of the time we consider small melanomas to be less than 2.5

 millimeters in thickness or height this is an example of a patient with a small melanoma

usually small melanoma are found in the macula and that's the center of site as you see in this

 picture here because there did because the tumour actually starts to distort the retina and

cause symptoms which bring a patient to attention another reason why small NIMH I often

 found here is because this is directly straight into the back of the eye in the easiest area to

detect on a dilated fundus exam the traditional approach of treating a small melanoma

actually is observation rather than immediate treatment and the question is why would be not

definitively treat a melanoma when it is small at the outset and I thought about this and there

 are some reasons why many ophthalmic oncologists may recommend observation only one

of the things that is true is that the risk of the cancer spreading or metastasis is low we know

that the smaller the melanoma the lower the risk that a patient may develop spread of the

cancer so a lot of people feel that well these are low risk cancers we don't necessarily need to

treat them immediately another concern is that there is worried that treatments for

 melanoma may blind the eye that is true we do use radiation to definitively kill the cancer

 cells of the melanoma however in our approaches we usually only require a small amount of

radiation to treat a small melanoma there are some traditional radiation protocols where more

radiation may be used and certainly a lot of radiation in the macula or the center the vision

can harm the vision finally treating a small melanoma in the macula may be challenging

because we actually have to get to the very back of the eye however this is not a concern or a

 challenge at a center where there is a lot of experience treating melanomas let me share with

you an example this is a 41 year old female who was found on diagnosis to have a small

melanoma and I've circled the melanoma here so you can see it's slightly elevated it's

 pigmented in this lesion with leak excuse me was leak fluid and she had seen a specialist who

 recommended that we need to wait for the tumor to grow to 3 millimeters to meet the

criteria before we can consider two melanoma and offer treatment I think that things are

changing now is we realize in medicine that early detection results in early treatment and better outcomes so why would we want to treat and we strongly feel that when we find a

 melanoma and it's small and early people do better the smaller the tumor the less the

radiation is needed to destroy the cancer of the eye and less radiation means less ocular side

 effects less vision loss less problems in the eye due to the radiation side effect also allowing the tumor to grow may worsen the prognosis for the patient and that is because there is a

direct correlation with tumor height and the ability of the cancer to spread so we don't want

the tumors to grow bigger than they are at their initial presentation and also from a biological standpoint we know that F tumors are left Arlette to grow they acquire more malignant

genetic markers within the tumors themselves that may increase the propensity of the

melanoma to spread in the body so what do we do when we see someone with a nevis or

something suspicious that we want to keep an eye on we evaluate people for growth and we do that by a number of tests including ultra sonography where we can check all of the dimensions

 of the lesion at the visits we look for any increase in activity of the tumor and I mentioned

 before leaking fluid is one of them so for example we can see change in activity by a change

in the pattern of the ultrasonic ultrasonographic features within the tumor itself and

sometimes we can see an increase in subretinal fluid that signifies that this benign spot is

 starting to change and we use our imaging studies and clinical examination to help us ideally

 it's wonderful if we can catch something like this before the tumor actually grows so that we

can treat the patient early let me share with you an example of another case this is a 63 year

old male who was found to have a pigmented spot in the macula he was seen by his

 optometrist and referred to our Center you can see the pigmented spot and there is some

orange coloration within it so it looks pretty suspicious at the time of his visit he had an Oct which stands for ocular coherence tomography and the scan was taken through the lesion

itself and I put that up here this indicates the lesion itself and over here you can see the overlying retina is slightly disturbed and distorted there may even be a little bit of fluid there

based on the black spaces two weeks later we repeated this and you can see that there is an

increase in the fluid overlying the tumor itself so this person actually had a small melanoma which he has had treated at this time this is another example of a patient who was found to

 have a flat pigmented spot in the eye and although we encourage people to be seen on a

regular basis he did not come back and six years later unfortunately was found to have a large melanoma that group of this spot this is a rare example as the majority of flat Nev I do not

turn into melanomas like this but this underscores the importance of having periodic

examinations by an air I care provider and to alert the physicians if there is any change in

 symptoms so I'd like to summarize small ocular melanoma must be treated early in order to maximize a person's vision and to reduce the chance of mortality from the cancer possibly

spreading it is important to have the correct diagnosis ensure that the follow-up and

treatment is appropriate and finally at our Center we recommend that all ocular need eye be

 monitored indefinitely thank you very much I welcome you to ask your questions via social

media and we'll do our best to answer them thank you so this is our one of our questions from someone in our audience I know that I have an eye freckle for how long should I continue

 with the annual examinations we recommend that people continue indefinitely to have the

eyes examined at the examination there are other things that can be monitored in addition to the nevis that has a rare chance of changing a person could have their vision monitored the

intraocular pressure can be checked and a once-a-year ocular examination is probably a good recommendation for most individuals I've had an I freckle for a long time but it's never posed

 any problem with my vision should I get it checked by an eye doctor we recommend at least a thorough examination before we continue to monitor on a less frequent basis a final question

is choroidal nevis hereditary most intraocular Niva are not hereditary but we do see that a person who may have a lot of freckles on their skin may be less pigmented this person may

 have less pigmentation as similar to many family members who may have less pigmentation so freckles may seem to run in the family but we don't find family members with with if the

 person has a freckle in their eye their siblings do too it is not as predictable as that thank you very much. Next Type of Cancer Lymphoma, Risk Factors, and Symptoms

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