The most common eye cancers in elderly patients primarily include **ocular melanoma** and **ocular lymphoma**, with ocular melanoma being the predominant primary malignancy affecting the eye in adults, including the elderly. These cancers arise from different tissues within or around the eye and have distinct characteristics, risks, and treatment considerations.
**Ocular Melanoma** is the most frequent primary eye cancer in older adults. It originates from the melanocytes, the pigment-producing cells found mainly in the uveal tract of the eye, which includes the iris, ciliary body, and choroid. Uveal melanoma is the most common subtype and typically occurs in people over 50 years old. It can present as a dark spot on the iris or a mass inside the eye, sometimes causing visual disturbances or changes in the appearance of the eye. This cancer is serious because it can metastasize, particularly to the liver, and requires careful monitoring and treatment. Advances in genetic testing of the tumor, such as gene expression profiling, help predict the risk of metastasis and guide personalized treatment plans. Treatments may include radiation therapy, surgical removal of the tumor, or in severe cases, removal of the eye (enucleation). New therapies like tebentafusp have been approved for metastatic cases in specific genetic profiles, improving outcomes for some patients.
**Ocular Lymphoma** is another important eye cancer in the elderly, often presenting as a type of non-Hodgkin lymphoma that affects the tissues around or inside the eye, such as the retina or vitreous. It can be primary (originating in the eye) or secondary (spread from other parts of the body). Symptoms may include blurred vision, floaters, or eye discomfort. Diagnosis often requires biopsy and specialized imaging. Treatment typically involves chemotherapy, radiation, or targeted therapies depending on the lymphoma subtype and extent.
Other less common eye cancers in elderly patients include **sebaceous gland carcinoma**, which arises from the oil glands in the eyelids and can mimic benign conditions like chalazion or blepharitis, leading to delayed diagnosis. This cancer is aggressive and requires surgical excision with careful margin control.
**Basal cell carcinoma (BCC)** and **squamous cell carcinoma (SCC)** can also affect the eyelids and surrounding skin in older adults, as these are common skin cancers linked to cumulative sun exposure. While not cancers of the eye itself, their proximity can impact ocular health and function.
Age-related changes in the eye and systemic health conditions common in the elderly, such as diabetes and hypertension, can complicate the diagnosis and management of eye cancers. Regular comprehensive eye exams are crucial for early detection, especially since symptoms may be subtle or mistaken for benign age-related changes.
In summary, ocular melanoma stands out as the most common and significant eye cancer in elderly patients, followed by ocular lymphoma and eyelid skin cancers like sebaceous carcinoma and nonmelanoma skin cancers. Early recognition, accurate diagnosis through biopsy and imaging, and advances in genetic testing and targeted therapies have improved the management and prognosis of these cancers in the aging population.