Ciliary Body Melanoma

Ciliary body melanoma is more likely to present with extrascleral extension (seen as dark spots on the sclera).

Malignant melanoma that originates in the ciliary body is termed, "ciliary body melanoma." The ciliary body is located immediately behind the iris and in front of the choroid. Therefore, it is hidden behind the iris. It is responsible for making the aqueous fluid that fills the front of the eye. The ciliary body is highly vascular and contains the melanocytes from which melanomas can grow. Compared to iris and choroidal melanoma, ciliary body melanoma is the most difficult to find.

Symptoms
Ciliary body melanoma patients usually have no symptoms. When symptomatic, patients present with an irregular astigmatism (due to the tumor pushing on the natural lens), sector cataract, tumor in the visual axis (line of vision) or secondary glaucoma.

Diagnosis
Ciliary body melanoma patients may present with a new astigmatism that is difficult to refract. Slit-lamp examination may reveal a "sentinel" episcleral vessel or evidence of extrascleral extension.

This enlarged episcleral blood vessel (arrow head) was induced by the underlying ciliary body melanoma.

Relatively small ciliary body melanomas are sometimes found by gonioscopy of the anterior chamber angle.

A hidden tumor, ciliary body melanoma can present as a small tongue of tumor (arrow) that extends from the ciliary body band (seen on gonioscopy).

Ophthalmic oncologists have found high-frequency ultrasound to be extremely valuable for the evaluation of ciliary body melanoma. Previously hidden behind the iris, even small ciliary body melanomas are being uncovered. Three hundred sixty degrees of ciliary body should be inspected during each high-frequency ultrasound examination of a ciliary body melanoma.

High-frequency ultrasound can reveal disinsertion of the iris (left), anterior iris displacement, or hidden ciliary body enlargement.

Ciliary body melanomas can grow completely around the eye to become a "ring melanoma."
Ring melanoma is highly associated with secondary glaucoma, different colored irises (heterochromia) and extrascleral tumor extension.

Ring melanoma is a form of ciliary body melanoma that can encircle the ciliary body, discolor the iris, cause ectropion uveae and displacement of the iris root.

Treatments
Most ciliary body melanoma can be treated like choroidal melanoma.

Small Ciliary Body Melanoma:
Patients with a small ciliary melanoma can be treated after their first visit, but since growth helps to prove that the tumor is a cancer, your doctor may suggest "observation" or watching for a small amount of tumor growth prior to treatment. Small ciliary body melanoma are typically treated by local resection or radiation therapy.

Medium-sized Ciliary Body Melanoma:
Around the world, most patients with a medium-sized ciliary melanoma are treated with either radiation therapy, surgery or removal of the eye. Almost all patients prefer not to lose their eye when eye and vision-sparing treatment options are available. Though the results of the Collaborative Ocular Melanoma Study (COMS) suggest that plaque radiation therapy and enucleation of the eye are equally effective for the prevention of metastatic choroidal melanoma, patients with ciliary body melanoma were not included in the COMS.

Large-sized Ciliary Body Melanoma:
A patient with a very large ciliary body melanoma is likely to be treated by removal of the eye (enucleation). This is because the amount of radiation required to kill a tumor which fills most of the eye, is just too much for the eye to tolerate. Patients with very large ciliary body melanoma can also be treated with eye-sparing radiation. The risks are that many of these eyes will become uncomfortable, have poor vision, and may have to be removed later.

Related Links
About Enucleation Surgery

About Plaque Radiation Therapy

While this WWW site is intended to provide general information as a public service, the content is not intended to represent official policies and practices of the institution or to substitute for health care provided by a clinician. Content and design copyright © Paul T. Finger, MD 1998-2010. ALL RIGHTS RESERVED •115 East 61st Street • New York City, New York 10021 • (212) 832-8170