Mom stopped what she was doing and looked over at me. \u201cOh Becky, don\u2019t do it,\u201d she said. \u201cMy cancer may have been caused by a sunlamp.\u201d<\/p>\n
I don\u2019t remember asking for details at the time, though her words made enough of an impact on me that I never went to a tanning salon. Over the years, my Mom and I occasionally talked about her cancer, especially when I started working at The Skin Cancer Foundation. Also known as uveal melanoma, ocular (meaning \u201cof the eye\u201d) melanoma is very different from cutaneous (\u201cof the skin\u201d) melanoma<\/a>. It\u2019s also rarer. With cases of ocular melanoma popping up in the news \u2014 including 50 people in North Carolina and Alabama<\/a> \u2014 it felt like it was time to help my mom share her story.<\/p>\n Mom first noticed something was wrong with her eye on Christmas Day, 1975, when she was 22 years old. She had recently finished nursing school and had moved back home to her parents\u2019 house in Beacon, New York. One of her brothers had received a pair of binoculars as a gift, and she was playing with them, focusing on the Christmas tree across the room. At one point she shut her right eye to create a telescope and realized she couldn\u2019t see clearly out of her left eye \u2014 her vision was cut off on an angle.<\/p>\n A couple of days later, she visited an optometrist who checked her eyes and said she needed new glasses. \u201cEven then I didn\u2019t think, \u2018It\u2019s got to be more than that,\u2019\u201d says Mom. \u201cI got the glasses, and within a week or two I started having more symptoms.\u201d<\/p>\n First, she started experiencing floaters. \u201cIt was like little dots blocking my vision,\u201d she remembers. \u201cIt would happen randomly. My vision would suddenly cut off in my left eye, so I got in the habit of closing that eye, and then I could see fine.\u201d<\/p>\n She contacted an ophthalmologist and made an appointment for two months later. In the meantime, things got worse and she started seeing flashes of light, \u201clike someone was taking a photo on my left side,\u201d she says. \u201cAt first I would turn to look, but then I got used to that, too.\u201d<\/p>\n Then she started having dizzy spells. During all of this, Mom continued working at a local hospital. One Friday while she was assisting a doctor with a procedure she began to feel faint. \u201cI remember I said, \u2018Doctor, I\u2019m going to pass out,\u2019 before I sort of slid down a wall.\u201d<\/p>\n The doctor moved her to an empty bed and called the nursing supervisor. They started asking Mom questions about her health, and she told them about her symptoms and that she had an appointment with an ophthalmologist scheduled for the next month. So, they sent her home early to rest.<\/p>\n That evening at home, she received a phone call from the ophthalmologist; the nursing supervisor had contacted him. After my Mom described her symptoms, he told her to come to his office first thing Monday morning.<\/p>\n My grandmother drove my mom to her appointment, where the ophthalmologist, Andrew Dahl, MD, looked carefully at Mom\u2019s eyes. After the exam, he sent her back to his office and got my grandmother from the waiting room. Then he told my mother that she had a tumor in the back of her eye.<\/p>\n \u201cThank God my mother was with me. She had the presence of mind to ask the doctor if it was malignant. I was just too stunned. I immediately started to wonder if I was going to die.\u201d<\/p>\n Dr. Dahl couldn\u2019t tell Mom if the tumor was cancerous. For that she would need more tests, so he recommended she see a tumor specialist at the Harkness Eye Institute at Columbia Presbyterian (now known as Columbia University Medical Center, New York-Presbyterian Hospital) in New York City.<\/p>\n Within a week, Mom was admitted to the hospital for four days of tests and scans. One of the tests she remembers most vividly was called a radioactive phosphorous (P32) uptake test. She was injected with a radioactive dye and then monitored for 48 hours, while the dye traveled through her body. If cancer was present, the radioactive phosphorous would attach itself to the cancer cells. She was put under general anesthesia while doctors cut into a muscle alongside her eye and used a radiation detector to see if there was a higher \u201cuptake\u201d of the dye in the eye compared to surrounding tissue.<\/p>\n If my Mom had been diagnosed today, the testing to confirm ocular melanoma would be very different. Brian Marr, MD, who heads the Ophthalmic Oncology Service at the Harkness Eye Institute, says that advanced imaging technology has replaced the P32 uptake test. Today, doctors use clinical examination, optical coherence tomography (OCT) and high-resolution ultrasounds to scan the tumors and make a diagnosis.<\/p>\n Unlike with many other forms of cancers, a biopsy isn\u2019t necessary to proceed with treatment. \u201cIn most cancer centers, if you don\u2019t have a pathologic diagnosis, no one will treat the patient because there\u2019s no proof it\u2019s really cancer,\u201d says Dr. Marr. \u201cBut because we\u2019re so accurate in diagnosing ocular melanoma with visualization through some of the imaging that we have, it\u2019s one of the only types of cancer we\u2019re allowed to treat without pathology.\u201d<\/p>\n As for my mom and her uptake test back in 1976: all the dye had traveled to her eye, which confirmed that the tumor was cancerous. Fortunately, the cancer hadn\u2019t spread beyond the tumor, which was encapsulated by a thin layer of tissue. But the tumor was beginning to grow and touch the optic nerve, which is what caused the flashing lights and dizziness.<\/p>\n The doctors at the Harkness Institute asked Mom many questions about her past to find out how far back symptoms may have gone. Once she started thinking about it, Mom realized how many times she\u2019d fainted as a teenager. She had lost consciousness several times after even just light hits on the head \u2014 once after being hit with a snowball. She had also passed out at three high school dances, each time when strobe lights were turned on. It\u2019s possible that her tendency to faint was tied to the tumor pushing on her optic nerve.<\/p>\n The doctors deduced that she had always had a mole in the back of her eye, but some sort of trauma had likely triggered it to turn into a cancerous tumor. That\u2019s when my mom remembered the sunlamp.<\/p>\n It was the 1960s, and she hated her pale legs then as much as I would in the 1990s. First, she tried lying out in the sun, on the roof of her parents\u2019 house, for hours. Each time, she held out hope that the inevitable sunburn<\/a> would turn into a tan. But it never did, so she bought a UV-emitting sunlamp from her local drugstore. She clipped the lamp to the desk in her bedroom and moved around so the light would hit her legs, arms, chest and face. She only used it two or three times and remembers burning herself badly enough that she decided it wasn\u2019t worth it. Though she kept the lamp for years, she never used it again.<\/p>\n Unprotected sun exposure can seriously damage the eyes and surrounding skin, leading to vision loss and conditions from cataracts and macular degeneration to eye and eyelid cancers, but experts say there\u2019s no known association with ultraviolet (UV) light and uveal (or ocular) melanoma<\/a>. \u201cIf you look at the tumors genetically, skin melanoma versus uveal melanoma, the genes are significantly different,\u201d explains Dr. Marr. \u201cIn skin melanoma we know that UV radiation<\/a> causes certain genetic mutations, which are found in the tumors, but we don\u2019t find those same types of mutations in the uveal tissue.\u201d<\/p>\n Another factor to consider: Unlike your skin, your eyes can filter out UV light. Most ocular melanomas begin in the middle of the eye (in a layer called the uvea). Both the cornea and lens protect the uvea and the light-sensitive retina by blocking 99 percent of UV radiation.<\/p>\n Mom acknowledges that she\u2019ll never be sure what caused her cancer. \u201cBut I often wonder if being that close to that lamp is what turned what would have been a benign mole in my eye into a melanoma.\u201d Even without evidence, her story and speculations were enough to keep me from tanning beds.<\/p>\n On the last day of my mom\u2019s hospital stay, the doctor who had administered the P32 uptake test confirmed the diagnosis of ocular melanoma. He told her that the treatment was relatively simple: She would need to have an enucleation \u2014 the removal of her left eye. If the cancer had spread, she would have needed more extensive surgery to remove muscles or bone surrounding the eye, as well as chemotherapy. Relatively speaking, she was lucky.<\/p>\n The doctor told Mom that the surgery could be done at the Institute, or she could have it done at the hospital in Beacon where she worked. She wanted to be near her friends and family, so she elected to have Dr. Dahl, her ophthalmologist back home, do the surgery for her.<\/p>\n Her surgery was scheduled for March 16, a week before what would have been her first appointment with Dr. Dahl if the nursing supervisor hadn\u2019t stepped in.<\/p>\nFirst Signs of Trouble: Angles, Floaters and Flashes <\/strong><\/h3>\n
Getting a Diagnosis of Ocular Melanoma <\/strong><\/h3>\n
Looking to the Past for Clues <\/strong><\/h3>\n
Deciding on Treatment <\/strong><\/h3>\n
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