Diagnosis

Symptoms

Ocular melanoma (OM) can manifest in many ways, but most people find out they have an OM tumor when they have blurring or perhaps a slight soreness in one of their eyes and go to see their eye doctor. They may even see an optometrist because things just aren’t right. Regardless, it's important that you regularly see an eye doctor so that if you do have OM, or any other ocular disease, it can be caught and treated early.
Symptoms of a primary ocular melanoma tumor typically include blurred vision, flashing lights, shadows and misting of the lens of the eye (cataract). Often times, though, no symptoms are present at all (or at least noticed by the patient) and OM may be diagnosed during a routine sight test by an optometrist or ophthalmologist.

Initial Diagnosis

Typically, your doctor will use a device called an ophthalmoscope (a small handheld microscope) to painlessly look inside your eye and check for abnormalities. Because of your pupil, the "window" into your eyeball, your doctor can see inside your eye easily and will not have to do a biopsy to determine if a tumor is actually present. Most of the time, the ophthalmologist can be nearly certain of the diagnosis from clinical appearance, photographs, and ultrasound pictures.

Size Determination

Your doctor will classify any found ocular melanoma tumor by the degree of pigmentation of the tumor, its shape and location, and by other features observed during the examination.

The size of the tumor is a large factor in the treatment protocol:

-Small: 1.0-2.5mm in height; greater than 5mm at the base
-Medium: 2.5 - 10mm in height; less than or equal to 16mm at the base
-Large: greater than 10mm in height; greather than 16mm at the base

A good overview of eye cancer can be found here on Duke's site.

Other Tests to Check For and Diagnose OM

Other tests and procedures may be used by your doctor to gain further insight into the type, size and other features of your tumor.

- Ultrasound scan - A small device which produces sound waves is rubbed over the skin around the eye area. The echoes are then converted into a picture by a computer.

- Colour fundus photography - Photographs of the back of your eye (fundus) will be taken, and can help to show what the tumour looks like before and after treatment. For the test, your pupil will be dilated using eye drops, and a special camera will be used to take a picture of the fundus.

- Fluorescein angiography - A special dye called flourescein is injected into a vein in the arm. In a few seconds the dye travels to the blood vessels inside the eye and a camera with special filters that highlight the dye is then used to photograph the flourescein as it circulates through the blood vessels in the retina and choroid. A rapid sequence of photographs is taken through your pupil which are then used in an OM diagnosis.

- CT (computerized tomography) scan - A CT scan takes a series of x-rays to build a three-dimensional picture of the inside of the head. The scan is painless but takes 10 minutes. It may be used to find the tumour within the eye, or to check for any spread of the disease.

- MRI (magnetic resonance imaging) scan - This type of scanner uses magnetism instead of x-rays to form a series of pictures of the inside of the head. The test can take about 30 minutes. It is completely painless, but some people feel a bit claustrophobic during the scan. It is also noisy, so you will be given earplugs or headphones to wear.

- Biopsy - A small sample of tissue may be taken from the suspicious area and examined under a microscope. However, this is not necessary for most ocular melanomas, because they have a distinctive appearance and can usually be recognized easily from the x-rays and scans.

Reactions to a Diagnosis

It’s normal to feel sad or even mad when you hear you have cancer. It's scary because of the unknown and because cancer can be a life-threatening disease.

If you've been told you have OM, it's important to ask as many questions as you can. Educate yourself by reading up on this site, the very informative National Cancer Institute site, and talking to other patients via OMF's Patient Forum.

Tell your close family members and talk about your reactions: your questions and your fears. Many patients choose to use a counselor. However you choose to come to grips with any new information from your doctor, make sure that you ask questions, seek second opinions, and know that nothing is final. In the case of OM, knowledge truly is power, so be your own advocate and push for new and better information, new trials, and the hope of a cure.