How to identify ocular cancer
Atlanta—Optometrists in a practice unaffiliated with a tertiary care center will rarely see patients ocular cancer, a disease that is both sight threatening and life threatening. Because it’s impossible to predict who will walk through your door, it’s necessary to remain vigilant for signs of ocular melanoma, basal cell carcinoma, ocular lymphoma and leukemia, as well as cancers that have metastasized to the eye.
“Most ocular melanomas are picked up by optometrists during routine eye exams, and prompt diagnosis is critical to survival,” says Optometry Times blogger Melanie Denton, OD, FAAO, MBA. Dr. Denton, who recently opened a practice in Salisbury, NC, gave a joint presentation on ocular oncology at SECO 2016 with Mark Dunbar, OD, FAAO, director of optometric services and optometry residency supervisor, Bascom Palmer Eye Institute, University of Miami Health System.
Ocular nevi are far more common than melanomas, but the challenge all eye practitioners face is distinguishing them. Lesion characteristics such as size, elevation, color, regularity of edges, and location should be evaluated. A typical nevus will be less than 3 mm elevation and 3 disc diameters in size with clearly defined margins and slate gray in color. Drusen also support the diagnosis of nevi.
If signs point to a flat choroidal nevus, it’s generally safe to take a photograph and then follow yearly, says Dr. Dunbar. With suspicious nevi, more frequent follow-up—every three to six months—would be appropriate.
If the lesion hasn’t changed after several follow-up visits, the period between exams can be lengthened to a year if you’re comfortable with that schedule. While there may be exceptions, a lesion that grows little, if at all, over an extended period is likely to be a nevus.
“If it’s been there a while, you can feel better about it,” Dr. Dunbar says.