The term choroidal melanoma refers to a malignant tumor formation in the eye. It is a primary tumor that develops directly in the eye itself and usually affects people of advanced age. Choroidal melanoma is the most common cancer in the eye.

What is a choroidal melanoma?

The term choroidal melanoma refers to a malignant tumor formation in the eye.

By the term choroidal melanoma, physicians understand a cancer of the eye that forms a malignant tumor.

This arises directly on the choroid, from which the name of the disease derives. This is the most common type of cancer in the eye: statistics show that it occurs approximately 6x in 100, 000 people. The most affected persons are those over the age of 50; a special accumulation is observed between the 60th and 70th year of life.

The disease is often detected at an advanced stage. Therefore, about half of the diagnosed choroidal melanomas are not treated until metastases have already formed in other organs.

causes

The causes of choroidal melanoma are not fully understood. The disease always occurs when melanin-containing cells in the choroid begin to degenerate and lead to malignant tissue growth.

So far, scientists have not yet been able to determine why some people experience this degeneration of the cells. It is believed that UV radiation has an influence on the development of the cancer.

However, this influence is estimated to be lower than in the formation of skin cancer (cutaneous melanoma). Also, a low presence of pigments should be associated with the susceptibility to choroidal melanoma. Fair-skinned people are about 150x more often affected by the disease, according to statistics.

Symptoms, complaints & signs

A choroidal melanoma initially causes no clear symptoms. Only with the progression of the disease does it come to different complaints, which mainly affect the eyesight. Thus sufferers often suffer from visual problems such as double vision or a blurred look. In most cases, a shadow appears in the field of vision, a so-called scotoma.

This manifests itself by a subjective darkening of the visual field on one or both sides, which increases in the course of the disease and ultimately leads to a permanently limited visual performance. In addition, a choroidal melanoma can lead to a distorted perception, worsening of foresight, or macropsia, in which objects are perceived larger than they are.

In some cases, the tumor can break through the dermis, which is noticeable for example by pain and an acute deterioration in vision. If the melanoma spreads to other parts of the body, more discomfort may occur. Depending on which body region is affected, functional failures of the internal organs, bones or skin may occur. Also the lungs and skin can be affected. Metastasis can be expressed in the form of pressure pain, paralysis, sensory disturbances and a general decrease in physical and mental performance.

Diagnosis & History

A choroidal melanoma is often not noticed by the affected person until the disease has progressed. If a doctor is consulted because of complaints such as poor eyesight or the sighting of shadows, it is not uncommon for the doctor to recognize the tumor during a general examination of the eye.

With the help of an ultrasound examination, the so-called echography, the size and the exact location of the tumor can be determined. If a choroidal melanoma is not treated, it comes after the visual disturbances in the further course to pain and possibly to a detachment of the retina.

As the disease progresses, the patient may lose his eye. If metastases spread and spread to the liver, the disease can be fatal.

complications

Treatment of the choroidal melanoma is essential and should be done as soon as possible. If no treatment is performed, the eye can not be saved. Since tumors can form in the body, death occurs in the worst case.

One of the common treatments is radiotherapy. The eye is preserved. Complications of this treatment are that the optic nerve itself has received too high a radiation dose. This can lead to partial or even complete loss of vision.

Another treatment option is the irradiation with a particle beam of nuclei of the hydrogen atom. The advantage here is that almost only the tumor can be irradiated and the adjacent tissue is spared. However, not every tumor can be treated with this method, as it depends on the size and location of this.

One last treatment option is the removal of the eye (enucleation). The tumor is removed in this case, but there is no complete certainty that secondary tumors have not already formed. Significant disadvantage, of course, is the irreversible loss of vision. Pain can occur after the procedure. In addition, though rare, there is the possibility of the formation of a bruise as well as an infection that may necessitate the removal of the inserted implant.

When should you go to the doctor?

Accompanying the fact that it is a tumor disease with a high risk of metastasis, a visit to the doctor is strongly advised. Suddenly a blurred vision or a generally deteriorated vision, as it often occurs in the case of a malignant uveal melanoma, the walk to the ophthalmologist is advisable.

Fair-skinned people, who already have moles on the choroid, are a high-risk group. However, most choroidal melanomas are discovered by chance during routine examinations.

If a choroidal melanoma is considered probable, the person concerned should not refrain from having it clarified as quickly as possible - even by taking a tissue sample. It has been found that the shape of the choroidal melanoma, in which the cells have monosomy 3, are particularly prone to metastasis. Investigations on possibly existing metastases should follow.

A choroidal melanoma can lead to a number of complications in unfavorable position and shape, which mainly involve the colonization of other organs with cancer cells. Accordingly, therapies for melanoma should not be postponed. Here, many treatment methods are open to those affected, the effectiveness of which is determined by the exact nature of the tumor.

Accompanying the therapy and also during the ophthalmologic follow-up is an examination of the liver, because it is particularly often affected by metastasis.

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Treatment & Therapy

If a choroidal melanoma has been diagnosed, the attending physician will initiate appropriate treatment. If the tumor has not grown too large, it can be treated with local radiotherapy (this is called brachytherapy).

For this purpose, a radioactive plate is sutured to the eye under local anesthesia and remains there for up to 14 days. Alternatively, the tumor can also be treated externally with proton radiotherapy. This therapy is also suitable for larger tumors. If all types of radiation are not available, the malignant ulcer may also be surgically removed.

If all these treatments fail, the eye must be completely removed (enucleation) to prevent the cancer from spreading to the rest of the organism. Even after a successful treatment of choroidal melanoma, a comprehensive physical examination must be taken on a regular basis to rule out lumps. Since the choroidal melanoma in rare cases, even a daughter tumor for a cancer in another location may be, the exact general examination is also advisable before the start of therapy.

If the disease is diagnosed and treated early enough, the chances of a complete cure are very good, as the cancer is generally limited to the eye for a very long time before metastases form.

However, recent findings on the likelihood of metastasis of the University Hospital Essen and the Charité Berlin suggest a different picture: the choroidal melanoma can form very early micrometastasis and metastasis occurs almost exclusively due to a monosomy 3. So it is not of the early detection of the tumor nor of his Size dependent.

Outlook & Forecast

The choroidal melanoma causes severe eye problems in most cases. Especially visual disturbances develop, whereby a visual deficiency can be formed, which was not present before. The everyday life of the affected person is hampered by the choroidal melanoma. In many cases, mental discomfort also occurs because patients are afraid of complete blindness. As a rule, the affected person on the eye completely blinds if no treatment is initiated.

In the treatment, in many cases, an irradiation is initiated, which, however, can also damage surrounding tissue. Although the underlying disease is removed, however, the person affected may suffer from further visual problems. In the worst case, the patient's eye must be completely removed. Subsequently, implants can be used to alleviate these discomforts.

However, in many cases there is a positive course of the disease if treatment is initiated early. There are no further complications. Life expectancy is usually not limited because the tumor can not spread very much.

prevention

Since the choroidal melanoma is a cancer whose causes are not yet known exactly, prevention in the true sense is not possible. However, if there are signs of deterioration of vision, a doctor should be promptly consulted to determine the exact cause and, if necessary, initiate therapy.

aftercare

Direct follow-up is not possible with choroidal melanoma in most cases. The tumor must be removed from the eye as quickly as possible to prevent further complications or metastasis. An early diagnosis and treatment of the choroidal melanoma have a very positive effect on the further course of the disease.

Usually the disease is treated by radiation therapy or surgery. The person concerned should take care to protect his body and to rest after therapy or after the procedure. Exhausting activities or other physical exertion and physical activity are foreseeable.

In particular, the region of the eyes must be protected with a choroidal melanoma and treated with care. As a rule, the tumor does not spread to the other regions of the body. However, regular examinations are still very useful and should be done by a doctor in any case.

Since the tumor can adversely affect the eyesight of the person affected, the patient must wear a visual aid to counteract these complaints. In most cases, the life expectancy of the person affected by the choroidal melanoma is not adversely affected.

You can do that yourself

After the diagnosis of choroidal melanoma, patients themselves can do a lot to accept the cancer and live a full life despite the disease. What is important is an active lifestyle with lots of exercise and a cancer diet that is adapted to the respective symptoms and complaints.

Patients should include their own experiences and make a dietary change that supports the healing process. Possible diets include the ketogenic diet, which is composed of fat, protein and low carbohydrates and sugar and the oil-protein diet with oil and protein-containing products. The patients can work out a suitable diet together with the doctor. Just as important as a healthy and active everyday life is the exchange with other stakeholders.

Choroidal melanoma patient support groups are the first port of call for cancer patients to share information. Good alternatives are Internet forums or even an advisory conversation with a psycho-oncologist. A choroidal melanoma can be treated well today and sufferers should take advantage of this fact to increase their wellbeing through hobbies and a busy life. This also helps with recovery and relieves pain, depression and other concomitants of the disease and therapy.

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