Ocular Melanoma Patient Guide

Surgery In some cases, the recommended treatment for ocular melanoma is surgical removal of the tumor. Surgery is often recommended for tumors of large size and for iris melanomas. Surgery may also be recommended after radiation.

Clinical Trials

There is some important information you should know about clinical trials in ocular melanoma:

• Trials help physicians determine which patients should receive which drugs in which order (sequence). • Trials may provide you access to therapies not yet approved by the FDA but that may be more effective. • Trials are usually (but not always) free to participate in and you may have more diagnostic tests while participating than you otherwise would have during regular treatment. Be sure you understand your health insurance policy and the coverage of the clinical trial so you are fully aware of what is covered and what is not.

Types of surgery include: • Enucleation

Removal of the eye is sometimes recommended in cases involving large tumors. Following enucleation, an artificial eye may be placed in the socket and, with the help of an ocularist, made to look like a natural eye. •  Iridectomy Removal of part of the iris where the tumor is present. • Iridocyclectomy Removal of part of the iris (iridectomy) as well as the ciliary body (cyclectomy) where the tumor is present. • Trans-Scleral Local Resection Removal of the tumor through an opening in the wall, or the white part, of the eye. This is often used when the tumor is large. A radioactive plaque may be placed over the treated area to reduce the risk of tumor recurrence. • Transpupillary Thermotherapy The temperature of the tumor is slowly raised, killing cancer cells and shrinking the tumor. This treatment is most often used for small tumors in the retina and choroid. • Cryotherapy The temperature of the tumor is lowered since melanocytes are susceptible to freezing. • Gamma Knife A focused, single dose of radiation is given to the tumor, sparing healthy tissue in and around the eye. • Intraocular Injections Injections in the eye are used to administer medications to treat a variety of ocular conditions. These medications may include steroids for inflammation and or anti- angiogenic factors, which shrink blood vessels. Intraocular injections might be used if changes have occurred to the retina and optic nerve (retinopathy) due to radiation. Adjuvant Treatment In skin melanoma, adjuvant treatment is treatment used after the primary treatment (most often, surgery), to prevent the spread of disease. It can also refer to treatment used in addition to the primary form of treatment. Currently, in ocular melanoma, all adjuvant treatments are in the clinical trial stage and nothing yet has been proven to show beneficial results. Other Possible Treatments

• You can choose to stop participating in a trial at any time.

Visit www.melanoma.org/clinical-trials to explore a database of clinical trials that may be right for you.

QUESTIONS TO ASK YOUR DOCTOR

> Do I need to have my eye removed? > What are the dimensions of the tumor? What does this mean for treatment options? > Will you do a biopsy of the tumor? Why or why not? > Will you test my tumor for genetic mutations? > Do mutations affect the risk for metastasis? > How do mutations affect treatment? > How will you determine if the cancer has spread? > What are my treatment options and what are the differences? > Should I get a second opinion or explore another treatment center with more experience with ocular melanoma? > Which treatment do you recommend? > What are the side effects of each treatment? How soon will those side effects emerge? > Will my vision be affected? > How will this diagnosis affect my normal, daily life?

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