What is the follow-up after treatment?
All patients who are diagnosed with ocular melanoma, whether uveal or conjunctival, require close follow up after primary treatment. This follow up may include seeing an eye doctor, ocular oncologist, radiation oncologist, and/or medical oncologist depending on the diagnosis and risk of recurrence.
It is relatively uncommon for treated uveal melanoma to come back in the same place in the eye. This is known as local recurrence and happens in less than 5% of people with uveal melanomas. However, about half of people with uveal melanoma eventually develop disease that spreads outside the eye, known as distant metastasis. In conjunctival melanoma, local recurrence in the eye is more common.
Follow-up visits after treatment are important to check for ocular melanoma recurrence, spread to distant organs, and to assess and treat any side effects of the treatment.
Typical follow-up exams and tests
Follow-up visits often involve eye exams, checking for symptoms, and blood and/or imaging tests to look for signs of distant metastases.
The affected eye is usually monitored for recurrence and any treatment-related complications. For example, eye exams may involve color fundus photography or ultrasound.
Follow-up visits are important even if the affected eye was removed to check for recurrence in the area around the eye or distant organs. Follow-up visits are also a time to discuss any side effects of treatment and how they can be managed to preserve vision as much as possible.
Patients may be referred to a medical oncologist who will be responsible for checking for recurrence of the melanoma throughout the body.
Imaging tests, such as chest x-rays, ultrasounds, CT scans, or MRI scans, can be used to detect the spread of melanoma to distant organs like the liver. Blood tests to check liver function may also be used to detect signs that the melanoma has spread to the liver.
Timing of follow-up visits
How often follow-up visits are needed depends on the individual circumstances, including the size and location of the tumor, whether there were any treatment-related complications, and how long ago the original ocular melanoma was treated. People at higher risk for metastasis may need more frequent follow-up. (Read more about ocular melanoma risk factors here.)
Early on, the visits may be fairly often (for example, every three to six months) for the first few years after treatment. This is particularly true for people at higher risk of recurrence, or those with treatment-related complications. For those at lower risk for metastasis, yearly imaging tests may be sufficient. Follow-up visits generally become less frequent over time (for example, after five years have passed since the original treatment).
People undergoing treatment for melanoma can discuss their individual risks for local recurrence, treatment-related complications, and distant metastasis with their doctor so they can make informed decisions regarding follow-up after treatment.