Do you have a mole like this on your eye? Let's talk about Conjunctival Melanoma!

Have you ever noticed a brown spot or a small lump on the white part of your eye? You may not have noticed it. But, it may not be as simple as you think. Today we are going to talk about a rare but potentially dangerous cancer of the eye.

What is Conjunctival Melanoma?

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Simply put, conjunctival melanoma is a rare type of cancer that can develop in your eye. Some people also call it ``Conjunctival Malignant Melanoma.'' Now you may be wondering what the ``conjunctiva'' is. It's the clear membrane that covers the inside of your eyelid, the white part of your eye (also called the ``sclera'') . To be precise, most of the time, this melanoma develops in the ``bulbar conjunctiva'', the mucous membrane that protects the white part of your eye.

This is actually a type of eye cancer (ocular melanoma). Melanoma begins when cells called melanocytes start to grow uncontrollably . These melanocytes produce the pigment called melanin that gives our skin, hair, and eyes their color. You may have heard of skin melanoma, and that's what it is. But this is one that affects the eyes. It's important to remember that this condition can sometimes be life-threatening .

How common is this situation?

In fact, conjunctival melanoma is a very rare cancer . It only accounts for 2% of all eye tumors. It also accounts for 0.25%, or about one-quarter, of all melanomas. However, it is said that the number of cases has increased slightly in recent years.

In Western countries, the incidence is between 0.2 and 0.5 per million people per year. It most often occurs in non-Hispanic white people. However, it can also occur in Asian, black, and Hispanic people. It is very rare in children .

Another thing, this conjunctival melanoma is not a type of eye cancer like `retinoblastoma` or `intraocular melanoma`. `Intraocular melanoma` is one that occurs in the middle layer of the eye (`uvea`), and it is the most common type of cancer that occurs in the eye. `Retinoblastoma` is one that occurs in the retina, which is at the back of the eye.

What are the symptoms of this?

There may be no symptoms in the early stages of ocular melanoma. However, if you develop symptoms of conjunctival melanoma, they may include:

• A pigmented (colored) mole inside the eye . Sometimes this mole may be colorless. In that case, it is called `amelanotic Conjunctival Melanoma` . `Amelanotic` means `lacking` melanin.
• This spot can be flat like a disc or raised like a lump (`nodular`).
• This is only in one eye (`unilateral`).

What is the reason for this?

Because conjunctival melanoma is so rare, researchers are still not sure what exactly causes it . Genetics may play a role, but it is not contagious or spread from person to person.

However, two conditions have been clearly linked to the development of conjunctival melanoma. These are:

• (`Primary Acquired Melanosis` – PAM): This is when you develop spots that are larger than 1 mm, and may be colored, that were not present at birth. This `PAM` condition can occur with or without abnormal cells.
• Conjunctival nevi: These are what we usually call birthmarks, moles or freckles.

Are there other risk factors?

There are several risk factors that contribute to the development of ocular melanoma in general:

• Having blue or green eyes.People with light-colored eyes are more likely to develop eye melanoma than those with brown eyes.
• Being white. White people are more likely to develop melanoma of the eye than people of other ethnicities.
• Getting older. This risk increases as you get older.

Scientists think that exposure to ultraviolet light may also be a risk factor.

What complications can this cause?

If left untreated, melanoma can cause blindness and even death .

How do you recognize this?

Your eye care provider (ophthalmologist) can detect conjunctival melanoma during a routine eye examination. If they suspect it, they may order tests like these:

• Ultrasound examination (`Ultrasonography`).
• Optical Coherence Tomography (OCT): This is a test that uses laser light to measure the thickness of the conjunctiva.
• Biopsy test.

If your eye specialist thinks that this conjunctival melanoma may have spread (metastasized) to other parts of the body, he or she may order further tests. For example:

• Blood tests .
• Other imaging tests such as a `PET scan`, a ` CT scan` (`Computed Tomography scan`), or an ` MRI scan` (`Magnetic Resonance Imaging scan`).

What is the treatment for this?

Your doctor will talk to you and help you choose the best treatment for your condition. Treatment may include any of the following:

• Surgical removal of the lesion.
• Cryotherapy (treatment using extreme cold).
• Radiation therapy and topical chemotherapy are only adjuvant treatments (i.e., not the first-line treatment). Radiation therapy may include brachytherapy and external beam radiation therapy .

What are the side effects or complications of the treatment?

Possible complications of surgery for conjunctival melanoma include:

• Scarring of your cornea.
• Infection.
• Double vision (`Diplopia`).

Possible complications of cryotherapy:

• Temporary or permanent damage to parts of your eye, even the cornea.
• Iritis (inflammation in your iris).

Possible complications of topical chemotherapy:

• Tearing.
• Eye irritation.
• Eye pain.
• Blepharospasm (eyelid twitching).
• Corneal scarring.

Complications that can occur from radiation therapy:

• Dry eyes.
• Temporary corneal abrasions.
• Loss of eyelashes.
• Focal cataracts.

If these treatments are not successful, your doctor may even have to remove the affected eye .

How quickly will I feel better after treatment?

How quickly you feel better depends on the type of treatment you receive . Your doctor will discuss this with you when choosing the treatment that is right for you.

Can conjunctival melanoma be prevented?

It's not possible to completely prevent conjunctival melanoma, but you can do some things to reduce your risk.

How can I reduce the risk?

You can reduce your risk of developing conjunctival melanoma by wearing good sunglasses and hats , especially when it's sunny outside. This will help protect you from UV rays. It may also be a good idea to limit your exposure to the sun.

What can I expect if I have conjunctival melanoma?

If you have conjunctival melanoma, if it is treated, the outlook for survival is good . However, you may experience some vision loss. If conjunctival melanoma spreads (metastasizes), that is, moves to other parts of the body, the condition can be more serious. If it does, it is most likely to spread to your lungs and lymph nodes .

How do I take care of myself?

Here are some things you can do to help take care of yourself:

• Schedule and attend appointments with your medical team on time.
• Eating well.
• Exercising regularly.
• Reducing stress.
• Learn about and access services for people with low vision and double vision.

When should I see my doctor?

If you notice anything new or concerning about your health or vision outside of your regular appointments, see a doctor immediately .

What is the difference between a conjunctival nevus and a conjunctival melanoma?

A conjunctival nevus is a noncancerous (benign) growth on your conjunctiva. In non-medical terms, a nevus is also called a mole, birthmark, or beauty mark. A nevus is not cancer, but there are cases where a conjunctival nevus can become cancerous, called a conjunctival melanoma .

If you notice a new spot, thickening, or worsening of a pre-existing spot on the white part of your eye, you should definitely see an eye doctor . Hearing that you may have conjunctival melanoma, a type of cancer, can be a mixed bag of emotions. However, it's best to get a proper diagnosis and start treatment as soon as possible. This will help you have the best possible outcome (prognosis).

Finally, things to remember

So, I hope you now have a good understanding of what we have talked about, conjunctival melanoma. The eye is a very sensitive organ . Therefore, if you notice a small change or something unusual in your eye, do not ignore it. Especially, be careful of new spots, dark spots, and lumps. Early detection and prompt treatment are very important in such conditions . Therefore, it is very important to have an eye examination at least once a year. If you have any problems, do not hesitate to talk to your doctor.