Uveal Melanoma Treatment: Choroidal and Ciliary Body Melanoma Explained

Being told that a dark patch inside the eye is a melanoma is frightening, and many people did not know the eye could develop this cancer at all. Uveal melanoma is rare, it behaves differently from skin melanoma, and today most patients keep their eye. Modern uveal melanoma treatment aims first to control the tumor and protect your health, then to preserve the eye and as much vision as possible.

This page explains how uveal melanoma is diagnosed, staged and treated, and what follow-up involves. Related pages cover prognosis and survival and liver surveillance and metastatic disease in more depth.

What is uveal melanoma?

The uvea is the pigmented middle layer of the eye wall. It has three parts: the iris (the colored ring around the pupil), the ciliary body (a ring of tissue behind the iris that focuses the lens and produces the fluid inside the eye) and the choroid (the layer of blood vessels beneath the retina). All three contain pigment cells called melanocytes. Uveal melanoma — also called ocular or eye melanoma — develops when some of these cells multiply out of control. About 90% of these tumors start in the choroid, 6–7% in the ciliary body and 2–5% in the iris.

Despite the shared name, uveal melanoma is a different disease from skin melanoma. It is driven by different genetic changes, most often in the GNAQ or GNA11 genes, and because the inside of the eye has no lymphatic vessels, it spreads through the bloodstream — mainly to the liver.

• Choroidal melanoma, the most common form, grows beneath the retina as a dome-shaped lump that can become mushroom-shaped once it breaks through the thin membrane under the retina. Small tumors can look very much like a benign choroidal nevus.
• Ciliary body melanoma is hidden behind the iris and is often larger when found. Clues include enlarged "sentinel" blood vessels on the white of the eye, a new cataract or shift in focus, or raised eye pressure. Ciliary body involvement is linked with a higher risk of spread.
• Iris melanoma is the least common type and the least likely to spread; it has its own page on iris melanoma.

Who gets uveal melanoma, and how common is it?

Uveal melanoma is rare. In US cancer registry data for 1975–2020, about 5.6 people per million were diagnosed each year (6.3 per million men and 5.0 per million women). The median age at diagnosis was 63 and the risk rises with age, although younger adults and, rarely, children can be affected. It is far more common in people of European ancestry: Black patients made up only 0.6% of US cases.

Recognized risk factors are fair skin, light-colored eyes and a tendency to burn rather than tan; ocular melanocytosis (extra pigment in and around the eye, present from birth); certain nevi (moles) in the eye or on the skin; and, uncommonly, an inherited change in the BAP1 gene. The evidence linking sunlight to melanoma at the back of the eye is weak and inconsistent, and in most people no specific cause is found.

What are the symptoms of uveal melanoma?

About 30% of patients have no symptoms, and the tumor is found during a routine dilated eye examination. When symptoms occur, they depend on the tumor's size and position. The most frequent are blurred or reduced vision (about 38% of patients), flashes of light (9%), floaters (7%) and a shadow or loss of side vision (6%). A tumor near the front of the eye may instead show up as a visible spot, a distorted pupil or raised eye pressure.

How is uveal melanoma diagnosed?

Uveal melanoma is usually diagnosed from its appearance and a combination of imaging tests, without a biopsy:

• Wide-field color photography records size, color and margins and provides a baseline for detecting growth.
• Ultrasound (A- and B-scan) measures thickness and base diameter, shows the "hollow" internal pattern typical of melanoma and can detect growth through the eye wall.
• Optical coherence tomography (OCT) shows fluid under the retina, present in about 92% of small melanomas.
• Fundus autofluorescence highlights orange pigment, a feature associated with growth.
• Fluorescein and indocyanine green angiography reveal the tumor's own blood vessels and help separate melanoma from look-alikes such as a choroidal hemangioma.
• Ultrasound biomicroscopy (UBM) or anterior segment OCT images tumors of the iris and ciliary body.

Conditions that can mimic melanoma include a nevus, congenital hypertrophy of the retinal pigment epithelium (CHRPE), bleeding under the retina, a hemangioma, a metastasis from another cancer and inflammation of the eye wall. Telling them apart is a core part of an ocular oncology assessment; each test is described on our page on how eye tumors are diagnosed.

Because uveal melanoma spreads through the blood, the first assessment also includes liver imaging — MRI is preferred, although ultrasound or CT can be used — and sometimes chest imaging. Reassuringly, metastases are detectable at diagnosis in only about 2–3% of patients.

A biopsy is not usually needed for the diagnosis. A fine-needle biopsy is considered when the diagnosis is uncertain, or to obtain cells for genetic tests that estimate the risk of spread; it is often performed at the time of plaque placement. See biopsy and genetic testing.

How is uveal melanoma staged?

Staging describes the tumor's size and extent. For melanoma of the choroid and ciliary body, two systems are used side by side. The COMS size categories, from the Collaborative Ocular Melanoma Study, group tumors by height (thickness) and largest base diameter:

These are the cut-offs most often used today; older reports and the 2026 NCCN guideline use slightly different limits. The AJCC (TNM) system assigns one of four size categories (T1–T4) from thickness and base diameter, refines the category when the tumor involves the ciliary body or grows through the eye wall, and combines it with information on lymph nodes (N) and distant spread (M) to give stages I to IV — see eye cancer stages.

Size closely tracks the risk of spread. In published series, the 5-year risk of metastasis was about 6% for tumors up to 3 mm thick, 14% for tumors 3.1–8 mm thick and 35% for tumors thicker than 8 mm.

What are the options for uveal melanoma treatment?

No single treatment suits every tumor. The recommendation depends on the tumor's size and position — especially its distance from the fovea (the center of sharp vision) and the optic nerve — the vision in both eyes, your general health and your priorities. Practice has shifted strongly toward eye-sparing treatment: in US registry data, radiation alone was used for 1% of patients in 1975–77 and for 58% in 2017–20, while surgery alone fell from 93% to 21%.

Observation and laser treatment

Borderline lesions without documented growth can be watched closely. In the COMS study of observed small tumors, 21% grew within 2 years and 31% within 5 years; confirmed growth is usually a signal to treat. Transpupillary thermotherapy (TTT) heats the tumor with an infrared laser. About 92% of small tumors regress, but about one in three recurs when TTT is used alone, so it is now mainly combined with a plaque. Photodynamic therapy (PDT) uses a drug given into a vein (verteporfin) that a low-energy laser activates inside the tumor, closing its blood vessels without radiation. Because of the risk of regrowth, stand-alone PDT is reserved for carefully chosen tumors with close monitoring — see photodynamic therapy and Prof. Türkoğlu's research below.

Plaque brachytherapy

A small curved disc carrying radioactive seeds — usually iodine-125 or ruthenium-106 — is stitched to the outside of the eye over the tumor, left for several days and removed in a second short operation. Treatment is planned and carried out together with radiation oncology and medical physics specialists. In a Dublin series published in 2026 (310 patients treated in 2010–2020 and followed for more than six years on average), local tumor control was about 96% with both plaque types and 95% with protons, and 94–96% of eyes were kept. More on the plaque brachytherapy page.

Proton and stereotactic radiotherapy

Protons release most of their energy at a set depth and then stop, so the dose can be shaped tightly around large tumors or those beside the optic nerve. Long-term series report local control of about 95% at 15 years, although about 16% of eyes were eventually removed; only a few dozen centers worldwide treat eye tumors with protons. Gamma Knife, CyberKnife and linear-accelerator systems focus many beams on the tumor without eye surgery, but radiation injury to the retina and optic nerve is common. Both are compared on the radiotherapy options page.

Surgery: local resection or enucleation

Selected ciliary body and front choroidal tumors can be removed through the eye wall while the eye is kept (transscleral resection); these operations are demanding and done at relatively few centers. Removing the eye (enucleation) is advised for very large tumors, optic nerve invasion, a painful blind eye, regrowth after radiation, or when a patient prefers it. An orbital implant is placed during surgery and a custom artificial eye is fitted once the socket has healed; the removed eye allows complete pathology and genetic testing. Read about enucleation and the artificial eye.

What are the side effects of radiation?

Radiation controls the tumor effectively but can also affect healthy tissue nearby. Most effects develop gradually, typically six months to three years after treatment, and are more likely with thicker tumors, tumors close to the fovea or optic nerve, and in people with diabetes or high blood pressure. Reported rates vary with the method and the tumor:

• radiation retinopathy and maculopathy (damage to the retina's small vessels, causing swelling and reduced central vision) — more than 75% of eyes after plaque treatment in some series;
• cataract — about 39% within 5 years in one series;
• optic nerve damage — about 8%; bleeding into the vitreous gel — about 7%;
• neovascular glaucoma — painful high pressure from abnormal vessels, the most common reason for removing an eye after radiation and more frequent after protons;
• thinning of the eye wall (scleral necrosis) — about 1%.

Injections of anti-VEGF medicines or steroids and laser treatment can limit retinal damage, and a cataract can be removed once the tumor is controlled (complex cataract surgery). Vision depends mainly on tumor size and position: in the Dublin series, about half of the eyes treated with ruthenium plaques kept vision of 20/200 or better at the last visit, compared with 28% after iodine plaques and 40% after protons, largely reflecting the different tumor sizes treated with each method.

What are the results of treatment?

Much of what is known about outcomes comes from the Collaborative Ocular Melanoma Study (COMS):

In a US registry analysis covering 1975–2020, 5-year relative survival was about 83% and has not changed over four decades, even as treatment shifted from removing the eye to radiation — a reassuring sign that eye-sparing treatment has not reduced survival. Across all tumor sizes, about 25% of patients develop metastases within 5 years and 34% within 10 years, with the risk closely linked to tumor size and genetics. These figures describe groups rather than individuals.

What does follow-up involve?

Follow-up has two parts. Eye examinations, frequent in the first years and spaced out later, check that the tumor is shrinking or stable and catch radiation side effects early. Liver surveillance aims to find any spread early, when more options are available. The 2026 NCCN guideline (US National Comprehensive Cancer Network) bases the schedule on estimated risk:

Risk is estimated from the tumor's size and location and, after a biopsy, its genetic profile. MRI, CT or ultrasound of the abdomen can be used. Prof. Türkoğlu coordinates this surveillance with medical oncology.

What is new in uveal melanoma research?

The status of new treatments changes quickly. As of September 2026:

• Bel-sar (belzupacap sarotalocan) — an investigational, laser-activated drug for small choroidal melanomas and indeterminate lesions. Its phase 3 trial, CoMpass, finished enrolling 108 patients in June 2026; results are expected in the second half of 2027. Available only in clinical trials.
• Neoadjuvant darovasertib — an investigational tablet taken before local treatment to shrink the tumor. In the phase 2 OptimUM-09 study, 24 of 42 patients (57%) who had been advised to have the eye removed and completed treatment were able to keep it; phase 3 testing (OptimUM-10) is under way. Available only in clinical trials.
• Tebentafusp (Kimmtrak) — approved by the US FDA in January 2022 for adults with metastatic or inoperable uveal melanoma who are HLA-A*02:01-positive, a tissue type identified by a blood test.
• Darovasertib plus crizotinib — for metastatic disease in HLA-A*02:01-negative patients. After a large randomized trial, an FDA submission began in 2026; the combination is not approved as of September 2026.

Trials are also testing whether drug treatment after eye therapy can prevent spread in high-risk patients; this approach is not yet proven.

Uveal melanoma care in Antalya, Turkey

Prof. Türkoğlu is a Professor of Ophthalmology and ocular oncologist with more than 20 years in ophthalmology; her academic career was at the Akdeniz University Faculty of Medicine. In her private practice in Antalya she reviews your earlier records, repeats the key measurements with photographs, ultrasound and OCT, and explains the findings to you and your family in plain language. She then plans treatment with you; where a method needs specialized facilities — radiotherapy (plaque, proton or stereotactic) with radiation oncology and medical physics, or systemic treatment with medical oncology — it is delivered together with the relevant specialist teams. Ocular oncology surgery, such as biopsy or enucleation with an orbital implant, is part of her practice.

Many patients from abroad begin with a remote review of their scans. If a visit is advisable, the length of stay depends on the treatment: an assessment often needs only one visit, whereas radiation treatment takes several days or longer and is scheduled in advance with the treating team. The international patients page explains travel and practical arrangements.