The signs melanoma, a type of skin cancer, are clear.
Moles that are either new or changed in appearance are the hallmark of the disease, which strikes more than 200,000 Americans every year, along with rough patches and color changes in the skin.
Cancerous lesions can pop up anywhere on the skin, but experts warn melanoma may strike an uncommon area for thousands of Americans: the eyes.
Melanoma has been known to pop up on eyelids, thin layers of skin that are often exposed to harmful ultraviolet (UV) radiation, which makes them prone to developing lesions. Left unaddressed, these cancers may infiltrate the inner layers of the eye and the brain, making them far less treatable.
But the cancer can begin in a place even without skin, such as inside the eye, in a form of the disease called ocular melanoma. Of ocular melanomas, there are several subtypes, including uveal melanoma and conjunctival melanoma.
The skin and eyes share the same cells called melanocytes, which produce melanin, the pigment that gives skin, eyes and hair their color. Damage and mutations in these cells lead to melanoma.
And while melanoma is commonly caused by sun exposure, uveal and conjunctival melanoma are not primarily associated with harmful UV light. Instead, people with lighter eye colors or pre-existing eye conditions like near-sightedness may be at a greater risk.
As melanoma, and skin cancer in general, is on the rise nationwide, eye doctors have urged Americans to keep up with regular eye exams every one to two years to detect potentially cancerous changes, and to be on the lookout for seemingly subtle changes like blurred vision, spots and irritation in or around the eye.
Dr Jacqueline Bowen, an eye doctor and president of the American Optometric Association, told the Daily Mail: ‘Skin cancer involving the eye can appear in several different ways.
‘Some start in or around the eye itself, while others spread to the eye from elsewhere in the body.’
About 1 million US adults are currently living with melanoma, the deadliest form of skin cancer, and about 212,000 will be diagnosed this year.
The mortality rate from the disease in the US is about two per 100,000 people, resulting in around 8,000 deaths per year.
And melanoma rates have surged over the past 30 years.
According to the American Academy of Dermatology, the rate of melanoma diagnoses in the US doubled from 1982 to 2011, and there was a 31.5 percent increase between 2011 and 2019, the latest figures available.
In women over 50, there has been a three percent increase in melanoma rates per year, while men under 50 have seen a one percent dip yearly. Rates among women under 50 and men over 50 have remained stable.
Are we neglecting the dangers to our eyes by focusing so much on skin when it comes to melanoma?
Comment now Two forms of melanoma that grow in the eye, subtypes of ocular melanoma, are uveal and conjunctival melanoma.
There are usually no symptoms in early stages of ocular melanomas, but as the diseases progress, patients may experience blurry vision, floaters or flashes in their vision and changes in pupil shape.
The exact causes are unclear, but experts believe the disease is more likely in people with lighter eyes and skin colors. The role of UV light in ocular melanomas’ development is unknown.
There are about 2,000 new cases of ocular melanoma every year, according to the Melanoma Research Foundation (MRF).
Conjunctival melanoma, developing in the conjunctiva (clear tissue over the eye), is exceedingly rare with roughly 130 cases per year in the US and fewer than one in 1 million worldwide.
Symptoms include irritation, redness or a sensation of something being stuck in the eye. As it progresses, it may lead to vision loss, blurry vision or a change in pupil size.
Uveal melanoma starts in the eye’s middle layer, called the uvea. It is the most common eye cancer. Like the other forms of eye melanoma, the causes are unclear, but it is not thought to be influenced by UV light.
Bowen said: ‘It’s important to note that some of the most serious eye cancers, particularly uveal or ocular melanoma, often cause no pain or vision changes in the early and even mid stages. Uveal melanoma is life-threatening because the retina is an extension of the brain, providing a direct pathway for cancer to spread if it goes undetected.
‘This is why annual comprehensive eye exams are essential, even when no symptoms are present. During every exam, doctors of optometry carefully examine the eye using specialized microscopes that can detect very small or early precancerous and cancerous lesions of the eye and surrounding structures.
‘Many eye cancers are found during routine exams before symptoms ever develop, which greatly improves outcomes.’
While there are no definitive cures for ocular melanoma, patients can be treated with a specialized laser therapy or plaque brachytherapy. These treatments kill the tumor and while doctors don’t declare patients ‘cured,’ they are considered to be what is called NED, no evidence of disease.
Bowen urged anyone who notices changes in their eyes or vision to visit an eye doctor as soon as possible, especially if symptoms last for several weeks or worsen.
‘Early detection matters at every age, including in children, where rare but life-threatening eye cancers such as retinoblastoma may only be detected through a comprehensive eye exam,’ she said.
