Treatment Options

Ocular melanoma (also called uveal melanoma) is rare, and treatment is often delivered through specialized centres with experience in eye cancers. Your care team will recommend options based on the tumour’s size, location, whether it has spread, and your vision goals.

Available Treatment Options

Radiation Therapy (most common for primary ocular melanoma)

Radiation is the most common treatment for melanoma of the eye. One common approach is plaque brachytherapy, where a small device (“plaque”) containing radioactive seeds is placed on the surface of the eye over the tumour for a set period of time. (Canadian Cancer Society)

For larger tumours or tumours close to the optic nerve, external radiation may be used. Some centres use specialized techniques such as proton therapy or stereotactic radiosurgery. (Canadian Cancer Society)

Surgery may be used in specific situations depending on tumour location and size. Some surgeries focus on removing the tumour, while others may involve removing the eye when the tumour cannot be safely treated with vision-sparing approaches or if the eye is painful and has poor vision.

Laser or Local Therapies (selected cases)

Some small tumours may be treated with specialized laser-based techniques, sometimes alongside radiation, depending on the tumour characteristics and centre expertise.

Systemic Therapy (when cancer is advanced or metastatic)

If ocular melanoma spreads beyond the eye (metastatic disease), treatment may involve systemic therapies such as:

Immunotherapy
Targeted therapy
Chemotherapy
Liver-directed therapies (when metastases are liver-dominant)

In Canada, treatment options can vary by province and individual eligibility, and your oncology team can explain what is accessible in your region.

Systemic Therapy for Metastatic Ocular Melanoma

When ocular (uveal) melanoma spreads beyond the eye, it is called metastatic disease. The liver is the most common site of spread. At this stage, treatment focuses on slowing disease progression, extending survival, managing symptoms, and maintaining quality of life. (Canadian Cancer Society)

Immunotherapy

Immunotherapy works by helping the body’s immune system recognize and attack cancer cells.

Unlike cutaneous (skin) melanoma, uveal melanoma behaves differently at a biological level. Traditional immune checkpoint inhibitors, such as nivolumab (Opdivo®) or pembrolizumab (Keytruda®) — have shown more limited effectiveness in metastatic uveal melanoma compared to their success in skin melanoma (NCCN Guidelines)

Research continues to explore new immunotherapy approaches that are more effective for this rare cancer subtype. Patients should speak with their oncologist about whether immunotherapy is appropriate based on their individual situation. (Melanoma Research Foundation)

Tebentafusp (Kimmtrak®)

Tebentafusp (brand name Kimmtrak®) is the first therapy shown in a randomized clinical trial to improve overall survival in patients with metastatic uveal melanoma. (New England Journal of Medicine, Nathan et al., 2021:)

Tebentafusp is a bispecific T-cell receptor therapy designed specifically for uveal melanoma. It works differently from traditional checkpoint inhibitors.

Important considerations:

It is approved for patients with unresectable or metastatic uveal melanoma
Patients must test positive for the HLA-A*02:01 genetic marker
HLA testing is required to determine eligibility
Access and public funding may vary by province in Canada

Your oncology team can explain whether you are eligible and discuss treatment access in your region. Clinical trials may also be available for patients who are not eligible for tebentafusp or who are exploring additional treatment options. Click here for more information on clinical trials

How to Talk to Your Care Team

When you’re dealing with a rare cancer, it’s completely okay to ask for clarity, explore second opinions where possible, and take time to think.

Many patients find it helps to:

Bring someone to appointments to take notes
Ask for written summaries, copies of reports, or test results (e.g., blood tests or imaging)
Keep a running list of questions on your phone

Questions you might ask

What treatment do you recommend for my tumour and why?
What are the goals of treatment (control tumour, preserve vision, reduce spread risk)?
What side effects should I expect right away and later?
Will I need to travel for my scans, or can any be done locally?

Content Acknowledgement & Sources

This page was informed by (and rewritten from) educational resources from:

Canadian Cancer Society – Treatments for melanoma of the eye (Canadian Cancer Society)
Health Canada – Clinical Trials Database (Canada)
Canadian Cancer Society & Q-CROC – Cancer Trials Canada announcement/news (Canadian Cancer Society)
Princess Margaret Cancer Centre – Ocular Oncology guideline document (background context) (University Health Network)
New England Journal of Medicine (NEJM) – (Tebentafusp in Metastatic Uveal Melanoma (Phase 3 Trial)
Nathan et al., 2021)
National Comprehensive Cancer Network (NCCN) Guidelines – (Uveal Melanoma)
Melanoma Research Foundation – (CURE OM Initiative)

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