The main factors in determining which treatment to choose may include the size and stage of the cancer, as well as the likelihood of preserving visual function. There is no major advantage in preserving an eye if a small melanoma in a crucial place has completely destroyed vision. Nor will doctors necessarily want to remove an eye that functions normally even if the tumor is large. Therefore, statements about treatment can only be general. It is important to remember that patients who have had enucleation (removal of the eyeball) and those who have had radiation therapy respond similarly when asked about the quality of their lives after treatment. The most important outcome for these people was surviving this cancer.

Choroidal Melanomas

Treatment of these depends on their size and how well the eye functions. The smaller the tumor, the less likely surgery will be needed unless the eye is badly damaged or vision is lost.

Small melanomas: Small choroidal melanomas can be treated by radiation therapy, such as brachytherapy, proton beam therapy, gamma knife therapy, laser therapy, including TTT, or surgery. Sometimes the tumor can be removed surgically. Enucleation (removing the entire eye) may be necessary if the eye is severely damaged by the tumor (for example, causing severe glaucoma). Choosing from among these options is a decision that should involve both you and your doctor.

Because it is often difficult to tell if a small tumor is malignant, your doctor may prefer to watch the tumor carefully to see if it grows before deciding on treatment.

Medium-sized melanomas: These can be treated by most approaches listed above with the exception of laser therapy or TTT. Once again, the choice of treatment is a decision that should involve both you and your doctor. Radiation and surgery appear to be equally effective, although some people who have radiation eventually need surgery. But radiation offers the best chance of preserving eyesight. The survival rate between these 2 treatments is the same.

Large melanomas: These are usually treated by surgery. Enucleation (removal of the entire eye) is the preferred surgery. Sometimes radiation is added, but recent studies have shown no advantage to this. Also doctors have begun treating large melanomas with plaque radiotherapy with fairly good results. The cure rate appears to be as high as with surgery. Most patients end up with poor vision in the eye, however. The advantage is they have avoided the cosmetic effect of losing the eye.

Melanomas of the Iris

Melanomas of the iris are usually small, slow-growing tumors. One option for people with an early stage iris melanoma is to wait and see if it grows. A series of special photographs help monitor the tumor. If the tumor begins to grow, the tumor and a portion of the eye may be removed. How much eye tissue must be removed depends on the extent of the cancer. Types of surgery for early iris melanomas include iridectomy (removal of part of the iris), iridotrabeculectomy (removal of part of the iris, plus some of the tissue that anchors the eye), and iridocyclectomy (removal of a portion of the iris and the ciliary body). Sometimes enucleation is the only option. Radiotherapy is another option in certain situations.

Ciliary Body Melanoma

These can be treated with either surgical removal of the tumor, if it is small enough or radiation therapy. In more advanced cases or if there is serious eye damage, enucleation may be needed.

Recurrent melanomas: Intraocular recurrence is usually treated by enucleation. Extraocular recurrences are treated with immunotherapy and/or chemotherapy, as are skin melanomas. For more information see the American Cancer Society documents, "Melanoma and Non-Melanoma Skin Cancers."

Treatment of Intraocular Lymphoma

This is often associated with lymphoma of the brain. Often the treatment of the two is combined. For more information see the American Cancer Society documents, "Non-Hodgkin Lymphoma" and "Brain and Spinal Cord Tumors in Adults"

Radiation therapy: Treating intraocular lymphoma may involve external beam radiation therapy to the eye and brain. Although this can be effective in treating the tumor in the eye, the lymphoma often comes back in other parts of the nervous system, such as the brain or spinal cord. Radiation therapy to the brain also includes the risk of some loss of mental abilities such as thinking, learning, and memory.

Chemotherapy: Most doctors now treat intraocular lymphoma with systemic chemotherapy (anticancer drugs that are injected into a vein and move throughout the body) or by injecting it directly into the spinal fluid (intrathecal chemotherapy). The best combination and dosage of the drugs is not yet established, and the choice may be influenced by the exact cell type (classification) of lymphoma. For more information on lymphoma classification and chemotherapy, refer to the American Cancer Society document, "Non-Hodgkin Lymphoma."

Many doctors recommend using a combination of radiotherapy (to the eye and brain) and either intrathecal or systemic chemotherapy to treat intraocular lymphoma. This combination is usually associated with a higher rate of side effects such as the loss of some mental abilities. Some doctors have used methotrexate injections directly into the eye. This has proved successful but can cause significant damage to the eye.

High dose chemotherapy along with bone marrow or stem cell rescue has been used in some patients with good results. For more about this see the American Cancer Society document, "Bone Marrow and Peripheral Blood Stem Cell Transplants."