Choroidal melanoma is a rare tumour involving the eye. It is usually diagnosed following routine eye examination, often presenting with no symptoms although some individuals do notice a variation in their sight prior to initial diagnosis. A careful watch is kept on any changes that may occur in small pigmented areas of the choroid (lining of the eye) as some of these small pigmented freckles do develop into larger tumours, Currently there is no way of predicting where or when these tumours will grow. Ocular examination at the clinic includes ultrasound measurements, photography and laser scanning techniques. These are routine for regular eye examinations. If the tumour is not active it will not grow, but if any growth is recorded then treatment will be undertaken. The clinician will make a decision based on the clinical evidence from all the investigations

Radioactive Plaque Treatment

A plaque is a small metal disc about the size of a twenty pence piece which has radioactive properties. It is used to prevent further growth of the tumour, sterilising the cells and, it is to be hoped, shrink the tumour. The plaque is attached to the outer surface of the eye which corresponds in area to the tumour of the inner lining choroid or ciliary body. This is done under general anaesthetic and remains in place for several days until a measured amount of radioactivity has been given. A further small operation is required to remove the plaque at the end of this time. During this period the patient remains in hospital and regular eye care will be carried out by the nursing staff who will be instilling antibiotic and steroid drops. A plastic shield will be placed on the eye between treatments for protection.

Proton Beam Therapy

Proton beam therapy is conducted at the Douglas Cyclotron Unit at the Clatterbridge Hospital on the Wirral in Cheshire. This is the only service within the United Kingdom but prior to that therapy an operation is required to be conducted at Gartnavel General to insert tantalum markers. These are small metal discs, numbering up to four, and are similar to sequins. They are placed on the surface of the eye corresponding to the edge of the tumour area which will lie beneath the tantalum markers. The position of these markers is crucial because it allows the Physicists at the Cyclotron Unit, using X-ray facilities, to accurately target the specific area of the eye with the proton beam. Once inserted the markers do not need to be removed unless they are found irritant to the eye. Although the initial surgical procedure is carried out under general anaesthetic at Gartnavel General Hospital the final delivery of therapy is conducted at the Cyclotron Unit several weeks after the initial operation.

It is a complex, but safe and controllable method used to treat cancer cells within the eye with a charged particle beam of radiation. Due to its accuracy it spared the surrounding tissues of lens, optic nerve and skin where possible. The aim of this treatment is to stop the tumour growing and requires two visit to the Clatterbridge Centre for Oncology. All travel and hotel arrangements are made for the patient and an escort by the Scottish Ophthalmic Oncology's Secretary at the Tennent Institute. The first visit to the unit is an overnight stay to meet the Physicists and staff members involved and to plan a treatment programme with clear explanations about every step of the process. The second visit lasts for five days, the first day to check that the treatment designed is complete and accurate followed by four daily sessions of treatment lasting up to 45 minutes per day. The rest of the day is free time to spend as the patient wishes. On completion of treatment the patient travels home with clear instructions for aftercare and a suitable follow up appointment is arranged for review at Dr Kemp's Clinic.

Enucleation

This is the medical term for the removal of an eye. This operation becomes necessary when the eye is unable to cope with the treatment or has contained a tumour that has grown in an uncontrolled fashion. It is rarely offered as first choice of treatment unless the tumour fills more than 30% of the eye, as all other treatments at this stage will be ineffective. Following enucleation of a patient's eye, the volume is replaced by an implant inserted into the eye socket and attached to the eye muscles which should allow some movement post operatively. The implant material is usually Hydroxyapatite which has been created from reconstituted coral. The implant should be permanent and will support the artificial eye which is placed over the surface of the conjunctiva and created at a later date, sometimes two months after the initial enucleation. The combination of implant and artificial eye allows a more natural appearance. It is normal for the eyelids to be slightly swollen following initial surgery and some bruising is to be expected. Frequent use of ice packs will help reduce the tissue reaction while the wounds heal. The temporary artificial eye, which is initially place at surgery, will remain keeping the socket shape and lid contours as normal as possible until the wounds have healthy which will allow replacement of the temporary artificial eye with a made to measure prosthesis from the Artificial Eye Clinic, also based at Gartnavel General Hospital.