Choroidal melanoma, also known as uveal melanoma, is a very rare tumor, but it is the most common malignant tumor inside the eye in adults. Symptoms often appear late. Various treatment options are available – on this page, we offer a comprehensive overview from diagnosis to personalized tumor treatment.
With over 1,000 uveal melanoma patients now treated, we at ERCM have unique expertise. This makes us the world's leading center for radiosurgical therapy for this type of cancer.
Modern radiosurgery enables innovative, non-surgical treatment. Learn more about pioneering precision medicine and its benefits.
The choroid, with its complex network of blood vessels, lines the inside of the eyeball. It lies between the retina and the white sclera of the eye, also called the sclera. The choroid performs important functions for your eye health. For example, it supplies the eye with nutrients and oxygen and also helps regulate incoming light.
Uveal melanoma develops from specific pigmented cells, the uveal melanocytes. The annual incidence rate is approximately 7 patients per 1 million people, with the risk of developing the disease increasing with age [1].
The choice of the best possible treatment strategy depends on several key factors: the size of the melanoma and its exact location, and the patient's age also plays a role in the prognosis.
Robot-guided, high-precision radiosurgery offers a promising first-line treatment option for many patients. In many cases, vision can also be preserved, depending on the individual's initial situation.
Using high-precision, robot-guided and image-guided methods such as the CyberKnife and ZAP-X systems, we can destroy small as well as medium to large melanomas, which are otherwise difficult to treat, in a single session and preserve the eye – without surgery [2, 3, 4].
Together with our experienced specialists, we offer our patients an effective, safe, comfortable and uncomplicated therapy with which choroidal melanoma can often be treated [2, 3].
The indication for treatment of this type of cancer is determined in close consultation with our partners at the Eye Clinic of the University of Munich (LMU). A case-by-case decision is made as to whether CyberKnife or ZAP-X treatment is the best and safest treatment option for you.
Choroidal melanoma is a cancer that initially grows flat and then gradually bulges, lifting the retina above it. At the center of the retina, which itself consists of 10 different layers, is the macula—the area of your sharpest vision.
Choroidal melanoma, which usually occurs unilaterally, can develop in various places, including the posterior pole of the eye, where there is also an opening for the optic nerve to pass through.
The diagnosis is often made between the ages of 50 and 60 [5]. Therapy should be initiated as soon as possible after diagnosis.
Initially, many patients usually experience no symptoms or visual impairment. Only as the melanoma grows do symptoms such as reduced vision or a shadow in the field of vision or visual field restrictions become noticeable. Rarely, an increase in intraocular pressure or a tumor penetrating the sclera is observed.
First, the eye is examined using direct and indirect ophthalmoscopy. This examination of the fundus of the eye is often also performed for other conditions (e.g., hypertension, diabetes).
An ultrasound scan is also performed to determine other factors. These include the tumor's prominence (prominence), the internal echo (reflectivity) – these are vibrations reflected back in the ultrasound that allow conclusions to be drawn about the cancerous tissue – the presence of blood vessels (signs of vascularization), and possible retinal detachment. A special angiography of the fundus of the eye also clearly visualizes the tumor's own blood vessels.
At diagnosis, only 1% of patients have metastases. These are often found in the liver.
There are various treatment options for patients with uveal melanoma, including radiation therapy, surgery, or robot-guided radiosurgery using the CyberKnife or ZAP-X therapy. Other radiotherapy techniques are also used. These include brachytherapy, which involves applying radioactive radiation carriers (ruthenium 106 plaques) to the sclera of the eye, conventional radiation therapy, proton therapy, and the older Gamma Knife method.
A previously widespread procedure was surgical removal of the eye (enucleation), particularly in cases of large initial lesions, with the aim of preventing metastasis. However, large studies have not been able to demonstrate a link between specific treatment methods for the primary tumor and the subsequent occurrence of metastases.
CyberKnife therapy and ZAP-X therapy are among the modern technologies that can treat choroidal melanoma on an outpatient basis, making them particularly comfortable for you as a patient. Unlike other procedures, we can work without fixation. This means your eye is simply immobilized using retrobulbar anesthesia, which is administered via a small injection in the lower eyelid.
In the unique robot-guided CyberKnife or ZAP-X therapy, accelerated photons are fired at the tumor with high application precision of less than 1 mm, damaging the tumor's genetic material (DNA) with this energy. This procedure should not be confused with conventional radiation therapy. Radiosurgical treatment of choroidal melanoma is highly precise and painless.
Since our therapy with the CyberKnife or ZAP-X is performed on an outpatient basis, a hospital stay is not required. The actual therapy session lasts an average of only about 30 minutes. For you as a patient, this means you can continue your normal daily routine. In most cases, you can return to your usual activities after treatment.
Current study data suggest that CyberKnife therapy is superior to surgery (with removal of the eye) in terms of physical and emotional quality of life [5]. Regular ophthalmologic and imaging follow-up examinations, initially approximately every 3 months, are important to ensure the success of the therapy.
This video shows a choroidal melanoma treatment in cooperation with the University Eye Clinic Munich (LMU). To date, over 1,000 patients have been treated with this method at the ERCM.
The increasing complexity of treatment options also means that your personal decision regarding therapy should always be based on your personal life situation. We will support you along the way and provide comprehensive advice on the best possible treatment plan for you. Contact us directly or use our contact form.
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Choroidal melanomas are malignant cancers. Their severity depends on several factors, including the size, location, and extent of the tumor. Smaller choroidal melanomas are often considered less dangerous, while larger or more aggressive forms of the disease may have a higher risk of complications and spread. Early detection and timely, appropriate treatment together with specialized ophthalmologists are crucial for the prognosis.
The need for immediate treatment depends on the individual situation. Very small and slow-growing melanomas that cannot yet be definitively classified as melanoma can remain under regular surveillance, while larger or faster-growing choroidal melanomas require immediate treatment.
Treatment of this cancer with the CyberKnife or ZAP-X is very well tolerated in most cases. However, as with all therapies, some risks and side effects may occur, including visual disturbances or irritation of surrounding tissue. In very rare cases, swelling or inflammation may occur. However, this is usually temporary. The exact risks depend on the size and location of the melanoma, as well as the individual response to treatment.
Yes, choroidal melanoma can recur even after successful treatment, although this is rare. A second radiosurgical treatment is possible in principle, but must always be tailored to the individual.
[1] Schuler-Thurner, B. Bartz-Schmidt, KU, Bornfeld, N., Cursiefen, C., Fuisting, B. et al., Immunotherapy for uveal melanoma: vaccination against cancer. Der Ophthalmologe 2015;112:1017-1021.
https://link.springer.com/article/10.1007/s00347-015-0162-z
[2] Lindner-Eibl, K., Fürweger, C., Nentwich, M., Foerster, P., Wowra, B. et al., Robotic radiosurgery for the treatment of medium and large uveal melanoma. Melanoma Res. 2016;26(1):51-57.
https://journals.lww.com/melanomaresearch/abstract/2016/02000/robotic_radiosurgery_for_the_treatment_of_medium.8.aspx
[3] Liegl, R., Schmelter, V., Fuerweger, C., Ehret, F., Priglinger, S. et al., Robotic Cyberknife radiosurgery for the treatment of choroidal and ciliary body melanoma. Am J Ophthalmol. 2023;250:177-185.
https://www.ajo.com/article/S0002-9394(22)00519-0/abstract
[4] Muacevic, A., Nentwich, M., Wowra, B., Staerk, S., Kampik, A., Schaller, U., Development of a streamlined, non-invasive robotic radiosurgery method for treatment of uveal melanoma. Technol Cancer Res Treat. 2008;7(5):369-374.
https://journals.sagepub.com/doi/10.1177/153303460800700503
[5] Klingenstein, A., Fürweger, C., Mühlhofer, A. K., Leicht, S. F., Schaller, U. C. et al., Quality of life in the follow-up of uveal melanoma patients after enucleation in comparison to CyberKnife treatment. Graefes Arch Clin Exp Ophthalmol. 2016;254(5):1005-1012.
https://link.springer.com/article/10.1007/s00417-015-3216-7