How rare is ocular melanoma in Canada?

Ocular melanoma is a rare cancer, accounting for approximately 3–5% of all melanoma diagnoses. It occurs in about 5 cases per million people each year. In Canada, approximately 200 people are diagnosed annually.

How is ocular melanoma diagnosed?

Diagnosis usually begins with a comprehensive dilated eye exam. Additional imaging such as ultrasound, retinal imaging, OCT, or angiography may be used. A biopsy is sometimes performed but is often not required.

What are the available treatment options?

Treatment depends on tumour size, location, and whether it has spread. Options may include radiation therapy (most common), surgery, laser therapies, or systemic treatment for metastatic disease.

What is prognostic testing?

Prognostic (genetic) testing analyzes tumour tissue to estimate the risk of metastasis. It does not change the initial eye treatment but may guide follow-up intensity and long-term planning.

Should I seek a second opinion?

Ocular melanoma may first be identified by an optometrist, ophthalmologist, or retinal specialist. Because this is a rare cancer, diagnosis and care are often guided by specialists with experience in ocular oncology. While access to second opinions or specialized centres may be limited in Canada, it is completely appropriate to ask about your options and what additional expertise may be available to you.

Is ocular melanoma the same as skin melanoma?

No. While both arise from melanocytes, ocular melanoma is biologically distinct from cutaneous (skin) melanoma. Treatment approaches and patterns of spread differ.

Has the cancer spread?

At diagnosis, your care team will assess whether the tumour is confined to the eye (primary disease) or if it has spread (metastatic disease). Imaging and blood tests may be part of this evaluation.

Will I lose my vision?

Many treatments aim to preserve the eye and as much vision as possible. However, vision changes can occur. Your specialist will discuss risks specific to your tumour and treatment plan.

Where is ocular melanoma treated in Canada?

Patients are typically referred to specialized tertiary centres with experience in eye cancers. Your ophthalmologist or oncologist can guide you through the referral pathway.

What Is Ocular (Uveal) Melanoma?

If you are newly diagnosed or looking to better understand ocular melanoma, this page provides an overview of what it is, how it develops, and what you need to know moving forward.

Ocular melanoma, also known as uveal melanoma, is a rare cancer that develops in pigment-producing cells (melanocytes) inside the eye. These cells are found in the uvea, the middle layer of the eye that supplies blood and nutrients to the retina.

The uvea has three parts, all of which can be affected:

Choroid (the most common site)
Ciliary body
Iris

Ocular melanoma is the most common primary cancer of the eye in adults, but it remains a rare form of melanoma overall. Because it develops inside the eye, it is often not visible and may not cause symptoms in its early stages. Many cases are detected during routine, dilated eye exams.

We have compiled a list of resources created to support individuals after diagnosis:

Signs & Diagnosis

Primary vs. Metastatic

Risk Factor & Causes

Treatment

FAQ's

Addtional Information

Signs & Diagnosis

Ocular melanoma may not cause symptoms early on. As the tumour grows, some people may experience:

Blurred or reduced vision in one eye
Flashes of light or floating spots (“floaters”)
A dark spot on the iris or changes in pupil shape
Eye redness, pressure, or pain
Bulging of the eye or changes in appearance

These symptoms can also be caused by other eye conditions. Any sudden or persistent change in vision should be assessed by an eye care professional.

Diagnosis typically begins with a comprehensive eye exam, often including pupil dilation. If ocular melanoma is suspected, additional tests may include:

Eye ultrasound
Retinal imaging and photography
Optical coherence tomography (OCT)
Angiography to examine blood vessels in the eye

A biopsy is not always required to make the diagnosis, but in some cases it may be done to better understand the tumour and guide treatment decisions.

Signs & Diagnosis

Primary vs. Metastatic Disease

Primary Ocular Melanoma

When the cancer is confined to the eye, it is referred to as primary ocular melanoma. Treatment at this stage focuses on controlling the tumour while preserving vision whenever possible. Many people live for years after treatment for primary disease.

Metastatic Ocular Melanoma

Ocular melanoma can spread beyond the eye, most commonly to the liver, but also to the lungs, bones, and other organs. This is known as metastatic ocular melanoma.

While not all cases progress to metastatic disease, ongoing monitoring is an important part of care. Even after successful treatment of the primary tumour, metastases can develop years later, making long-term follow-up and surveillance essential.

Primary vs. Metastatic Disease

Risk Factors & Causes

Risk Factor & Causes

The exact cause of ocular melanoma is not fully understood. It is believed to result from genetic changes that occur in melanocytes within the eye.

Factors associated with increased risk include:

Light-coloured eyes (blue or green)
Fair skin
Increasing age
Certain inherited genetic mutations, including BAP1
Pre-existing pigmentation conditions involving the eye

Many people diagnosed with ocular melanoma have no known risk factors.

Treatment, Care & Moving Forward

Treatment

Treatment depends on tumour size, location, spread, and individual circumstances. Options may include:

Radiation therapy, such as plaque brachytherapy or proton beam therapy
Laser-based treatments for selected small tumours
Surgery, including tumour removal or, in advanced cases, removal of the eye
Systemic treatments (affecting the whole body), such as immunotherapy and targeted drug therapies, for metastatic disease

New therapies continue to emerge, and clinical trials play an important role in advancing care for ocular melanoma.

Ocular Melanoma: Innovative Treatments and Beyond

FEBRUARY 2019

With Dr. Marcus Butler, Princess Margaret Cancer Centre, Toronto, Canada & Dr. Omid Hamid, The Angeles Clinic and Research Institute, Los Angeles, California

This webinar provides an update on the landscape of metastatic ocular melanoma treatment in Canada and the United States. Dr. Hamid and Dr. Butler share their knowledge of current practices and care pathways, identifying the most pressing needs for patients. They also discuss new and emerging treatment options such as IMCgp100 (now named Tebentafusp or brand name Kimmtrak), as well as clinical trials available to Canadian patients with ocular or uveal melanoma.

An ocular melanoma diagnosis can affect vision, emotional well-being, and daily life. Even with vision loss in one eye, many people adapt and continue to live full, active lives.

Support may include:

Vision rehabilitation services
Mental health and peer support
Long-term monitoring for metastatic disease
Access to patient advocacy organizations and clinical trials

Connecting with specialized providers and patient communities can make a meaningful difference throughout the journey.

Because ocular melanoma is rare, patients are often referred to specialized centres with experience in eye cancers and rare melanoma subtypes.

In Canada, referral pathways commonly involve:

Optometrist or ophthalmologist identifies a suspicious lesion
Referral to an ocular oncologist or tertiary eye centre
Coordination with medical oncologists, radiation oncologists, and hepatology teams for surveillance and treatment

Specialist care is typically delivered through major academic hospitals and provincial cancer agencies.

Helpful Canadian resources:

Canadian Cancer Society – Finding Cancer Care
Provincial cancer agencies (e.g., Cancer Care Ontario, BC Cancer, Alberta Health Services)
Rare cancer referral networks and clinical trial registries

Patients are encouraged to ask about second opinions, clinical trials, and multidisciplinary care teams experienced in ocular melanoma.

Newly Diagnosed

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Ocular melanoma may first be identified by an optometrist, ophthalmologist, or retinal specialist. Because this is a rare cancer, diagnosis and care are often guided by specialists with experience in ocular oncology. While access to second opinions or specialized centres may be limited in Canada, it is completely appropriate to ask about your options and what additional expertise may be available to you.
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FAQ's

Addtional Information

Ocular (uveal) melanoma accounts for approximately 3–5% of all melanoma diagnoses.
In Canada, the estimated incidence is 5–6 cases per million people per year, translating to roughly 200-250 new cases annually.
About 40–50% of patients will eventually develop metastatic disease, often years after initial diagnosis.
The liver is involved in up to 90% of metastatic cases.

Sources:

Canadian Cancer Society: https://cancer.ca
Public Health Agency of Canada: https://www.canada.ca/en/public-health
Rare Disease Database (Orphanet): https://www.orpha.net

NOTE: The information on the Ocumel Canada website is not intended to replace the medical advice of a doctor or healthcare provider. While we make every effort to ensure that the information on our site is as current as possible, please note that information and statistics are subject to change as new research and studies are published.

Addtional Information

Together, we can make a difference.

Making awareness and education available is crucial. Since 2019, Ocumel Canada has worked to raise awareness of ocular melanoma focusing on education, and the need for improved patient care.

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What Is Ocular (Uveal) Melanoma?

If you are newly diagnosed or looking to better understand ocular melanoma, this page provides an overview of what it is, how it develops, and what you need to know moving forward.

Signs & Diagnosis​

Primary vs. Metastatic Disease

Primary Ocular Melanoma

Metastatic Ocular Melanoma

Risk Factors & Causes

Factors associated with increased risk include:

Treatment, Care & Moving Forward

Ocular Melanoma: Innovative Treatments and Beyond

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How rare is ocular melanoma in Canada?

How is ocular melanoma diagnosed?

What are the available treatment options?

What is prognostic testing?

Should I seek a second opinion?

Is ocular melanoma the same as skin melanoma?

Has the cancer spread?

Will I lose my vision?

Where is ocular melanoma treated in Canada?

FAQ's

Addtional Information

Together, we can make a difference.

Signs & Diagnosis