After you’ve been diagnosed with uveal melanoma (also called ocular melanoma), it’s important to take note of your health to watch for signs that the cancer may have spread (metastasized) beyond your eye. Some people are at higher risk of metastatic uveal melanoma than others. There are some clues that could indicate you have an increased risk of metastatic uveal melanoma, including:
- Tumor size. The larger the tumor in your eye, the more likely it is to spread. For every 1 millimeter increase in size, there is a 5% higher risk. The earlier the tumor is found, the smaller it will be, improving your chances of the cancer not spreading.
- Blood supply to the tumor. Tumors that are highly vascularized have a higher likelihood of spreading. That means they have many blood vessels providing the tumor with nutrients.
- An orange pigment overlying the tumor
- Your age at diagnosis. The younger you are when diagnosed, the less likely it is for your cancer to spread.
New research shows that gene mutations and changes in the chromosomes may also predict if your cancer will spread.
Following Up After Cancer Treatment
Once your cancer treatment is finished, you will have follow-up appointments with your oncologist (cancer doctor) or cancer team to make sure the cancer has not returned. They’ll also look to find any spread as early as possible. There is no set plan for follow-up after treatment for uveal melanoma. Oncologists watch their patients according to their own experience and preferences.
Most often, you would come back for blood tests every 6-9 months or so. These blood tests can look for levels of certain substances that may be higher if you have metastatic uveal melanoma. Another blood test, a liver function test, can show if your liver is damaged, which could mean there are tumors in the liver.
Imaging tests are also part of treatment follow-up. Since most metastatic uveal melanoma affects the liver, images may find tumors before any symptoms of liver damage. These tests may be done once or twice a year for up to 5 years, although your oncologist may want you to continue the scans for longer. Tests could include:
- CT scan
- PET scan
Ultrasounds can detect masses, but not small ones – those smaller than 10 mm in size. MRIs seem to offer the best results.
If uveal melanoma has spread to the liver, there are usually several masses, not just one or two.
How Is the Spread Diagnosed?
Although the liver is most often the organ affected by uveal melanoma spread, it can also go to the lungs, skin, or bones. If you experience any symptoms that concern you, it could mean your cancer has spread. Your oncologist will send you for other tests.
The most common symptoms that your cancer may have spread to your lung include:
- Coughing up blood
- Being short of breath
- Chest pain
- Having fluid around the lungs
- Not having an appetite
- Losing weight unintentionally
Tests to diagnose lung metastases include:
- Blood tests
- Chest X-ray and other imaging tests
- Mediastinoscopy, a surgical procedure that allows the surgeon to insert a tube to look inside the chest and take tissue samples for biopsies
The most common symptoms of bone metastases include:
- Easily broken bones
- Spine compression, which might lead to:
- Numbness or weakness in legs
- Back pain
- Loss of control of bladder or bowels
- High levels of calcium in the blood, which might cause:
- Sleepiness or sluggishness
- Muscle weakness or aches
- Urinating a lot
- Feeling extremely thirsty and drinking a lot
To diagnose spread to your bones, your oncologist may recommend:
- X-rays and other imaging tests
- Bone scan
And for skin metastases, the usual test is a skin biopsy. How the lesions look can vary quite a bit. Some can be red or pink spots, others flesh-colored. Some are smooth lumps and rough ones. Areas usually affected the:
- Abdomen, trunk, and chest
- Arms and legs
Can Ocular Melanoma Spread Be Predicted?
Since there are not many tests to check for metastatic uveal melanoma, oncologists rely on tests that indicate your risk of the spread.
Biopsies: Although biopsies are not common for eye cancers, your oncologist might want you to have one to check for gene changes that may raise your risk of the cancer spreading. The biopsy results can also guide your doctor to the right targeted drugs if you have those mutations.
There are a few types of biopsies that can be done for eye cancers:
- Fine needle aspiration involves your doctor inserting a very thin needle into your eye to remove a sample of gel-like liquid, the aqueous humor, found between the cornea and the lens. This liquid is sent for testing.
- Fine needle biopsy is similar to aspiration, but the needle is inserted directly into the tumor itself and cells are removed for testing.
- Incisional or excisional biopsies allow a surgeon to cut out part or all of the tumor for testing.
- Liquid biopsies are blood tests done to check for tumor cells in the blood. This type of test is not widely available yet because of the equipment needed. But the American Cancer Society says liquid biopsies can help predict the risk of the cancer coming back.
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American Cancer Society: “Tests for Eye Cancer,” “Lung Metastases,” “Bone Metastases.”
American Osteopathic College of Dermatology: “Metastatic Skin Cancer.”
Anticancer Research: “Serum Markers to Detect Metastatic Uveal Melanoma.”
European Journal of Ophthalmology: “Influence of Age on Prognosis of Young Patients with Uveal Melanoma: A Matched Retrospective Cohort Study.”
Johns Hopkins Medicine: “Mediastinoscopy.”
Indian Journal of Ophthalmology: “Using risk factors for detection and prognostication of uveal melanoma.”
Mayo Clinic: “Bone metastasis.”
Ocular Melanoma Foundation: “Testing & Prognosis.”
Osteopathic Family Physician: “Skin as a site of metastasis.”
StatPearls: “Lung Metastasis.”
Ocular Oncology and Pathology: “Liver Imaging Techniques: Recognition of Uveal Melanoma Metastases.”