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Epidemiology

In the UK, eye (ocular) cancers account for around 880 new diagnoses annually, with uveal melanoma being the most common subtype; the choroid is the most frequently affected site (2). A subset study in England (2006–2010) estimated approximately 382 cases per year (≈88%) involve the choroid, while around 52 cases (≈12%) involve the ciliary body or iris (1). Other sources suggest choroidal involvement ranges from 85–90%, ciliary body 5–8%, and iris 3–5% (3,4).

Clinical Features

Choroidal melanomas often remain asymptomatic until advanced; they may present with blurred vision, flashes, floaters, or visual field loss (6). Ciliary body melanomas (≈5–10%) may display signs such as dilated episcleral (“sentinel”) vessels, lens displacement, anterior uveitis, or retinal detachment—often diagnosed late due to hidden location (7). Iris melanomas (≈3–5%) may manifest as visible iris masses, pupil shape change, or pigment dispersion; they are generally less aggressive and more akin molecularly to cutaneous melanoma (6).

Investigations

Initial assessment includes clinical examination (biomicroscopy, indirect ophthalmoscopy, slit lamp) and ocular ultrasound for internal lesion characterization (6). Fine‑needle aspiration biopsy (FNAB) may be used in select cases for prognostic molecular testing (7). Once diagnosed, staging involves blood tests (liver function), chest X‑ray, liver ultrasound or MRI, and potentially PET/CT to detect metastases (8). Prognostic molecular profiling—e.g., gene expression profiling (DecisionDx‑UM)—is used to stratify metastatic risk (9).

Treatment

Management aims to control the primary tumour while preserving as much vision as possible and reducing the risk of metastases. Options include radiotherapy, local resection, or removal of the eye in advanced cases (3,6,7). The choice depends on tumour size, location, and patient factors, and is guided by multidisciplinary team discussion in specialist ocular oncology centres. Systemic therapy for metastatic uveal melanoma is limited, but tebentafusp has been approved in the UK for eligible patients, showing a survival benefit (10).

Prognosis

Over 50% of patients eventually develop metastases, most commonly to the liver (6). UK ten-year survival for ocular cancers is around 60%, though this includes conjunctival and other types—not uveal‑specific (2). Prognosis is worse with choroid and ciliary body tumours compared to iris melanoma; iris melanomas tend to have better long-term outcomes (6). Molecular features such as monosomy 3, BAP1 mutations, and gene expression profiles (e.g., DecisionDx‑UM class 2) indicate higher metastatic risk (9).

References

1. Keenan TDL. Uveal melanoma in England: trends over time and proportions by site. Br J Ophthalmol. 2012.
2. Cancer Research UK. Eye cancer statistics. Available from: https://www.cancerresearchuk.org
3. Kaliki S, Shields CL. Uveal melanoma: rare but deadly cancer. Eye (Lond). 2017;31:241–257.
4. Sevgi M. Uveal melanoma. Eye News UK. 2023.
5. Soliman N. Choroidal melanoma mini review. PMC. 2023.
6. Wikipedia. Uveal melanoma: types, symptoms, investigations. 2025.
7. Wikipedia. Ciliary body melanoma. 2023.
8. Modernod case report. Uveal melanoma investigations. 2021.
9. Wikipedia. DecisionDx‑UM prognostic test. 2025.
10. The Guardian. Tebentafusp approved in UK/NHS. 2024.