A brown spot on your eye may be an eye freckle. In very rare cases, it may be a type of cancer known as ocular melanoma. Eye specialists will monitor the spot and recommend treatment if it becomes cancerous.

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If you see a brown spot on your eye when looking in the mirror, you may be concerned and want to know what it is and what might have caused it. The spot may appear like a splotch of brown on the colored part of the eye (iris) or the clear film covering the eyeball (conjunctiva).

In most cases, a brown spot on the eye is harmless and is a mole inside the eye. In very rare cases, it could be a type of cancer known as ocular melanoma.

This article will explain more about each of these possibilities, what causes them, and treatment options that you might consider discussing with your doctor or eye care team.

A brown spot on the white part of your eye or eyelid is most often something called a nevus (or nevi, if there’s more than one). It’s also known as a mole or eye freckle — it’s just like a freckle on your skin, except it appears on the eye.

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These freckles can be located in a number of places on your eye, including the:

  • white part of your eye
  • clear covering of your eyeball (conjunctival nevus)
  • iris, or colored part of your eye (iris nevus)
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In very rare cases, the brown spot could be a type of cancer known as ocular melanoma. This is an extremely uncommon type of cancer, with an incidence of 5 per million adults, according to the National Organization for Rare Disorders.

It can occur in the middle layer of the eye, which may not be seen when looking in the mirror.

About your eye

The white part of the eye is called the sclera. This is the protective outer layer of the eye, and the muscles that move the eyeball are attached to it. The sclera makes up the majority of the eye surface.

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A nevus is made up of melanocytes. These are the same cells that produce melanin, the pigment that colors our skin, hair, and eyes.

Usually, melanocytes are spread out evenly in body tissue. When some of them clump together, they can cause nevi, or freckles. People can be born with nevi, or the nevi can develop later.

According to the American Academy of Ophthalmology, there may be a link between being exposed to ultraviolet light and then developing nevi.

Ocular melanoma starts in melanocytes. The exact cause of ocular melanoma is not known, but it’s thought that there are multiple factors, including genetic and environmental ones. DNA mutations or abnormalities are generally the basis for cells turning into cancer cells.

There are also some risk factors, like having light-colored eyes, fair skin, and a disorder called dysplastic nevus syndrome, also known as atypical mole syndrome.

Nevi typically have no symptoms. You may only notice you have one when looking in the mirror.

For ocular melanoma, there may not be any symptoms initially. When you do start to notice symptoms, they may be symptoms of other eye issues. This is why it’s important to see your doctor or eye care team when you begin to notice any changes to your eyes or vision.

Symptoms of ocular melanoma may include:

  • any changes in the shape or size of the pupil
  • bulging eyes
  • changes in your eyeball’s position in the socket
  • dark spot on the iris that gets bigger
  • flashing lights or floaters
  • blurry vision or losing part of your vision

When to seek medical care

If you see a brown spot on your eye, consult your doctor or eye care team as soon as possible.

If the brown spot is an eye freckle, your eye care team will want to monitor it consistently.

While it’s very unlikely for a brown spot to be ocular melanoma, an eye freckle can develop into cancer over time. If an eye freckle does appear cancerous after testing, then your doctor will work with you to develop a treatment plan.

If you begin to have any symptoms such as the ones mentioned above or notice pain or other changes in your eyes or vision, see a doctor.

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Your doctor or eye care team will not remove a harmless brown spot, as they do not want to risk damaging your eye.

If the spot is cancerous, they may suggest various treatments to treat it.

For a nevus or nevi, a doctor will typically monitor it and take pictures every year. This will help them compare images to make sure the spot isn’t growing or showing signs of cancer.

A noncancerous nevus may only be removed if it’s on the outside of the eye and affecting the appearance of the eye.

If the spot is ocular melanoma, treatment may be required. For a very tiny melanoma, some doctors may suggest a watch and wait approach.

The main therapeutic options for ocular melanoma are radiation therapy or surgery. Brachytherapy is often used for radiation. It involves inserting a radioactive disk into the eye socket near the tumor. The disk is secured and left in place for a few days. Sometimes, external beam radiation therapy is used instead.

In 2022, the Food and Drug Administration (FDA) approved Kimmtrak, an immunotherapy drug, for use for uveal melanoma that can’t be surgically removed. In order to have this therapy, though, you’ll need to have a blood test to see if you have a specific human leukocyte antigen.

Depending on the location of the melanoma, a doctor will surgically remove the affected area of the eye, or in very rare cases, the entire eye.

If you have a brown spot on your eye, it could be an eye freckle, also known as a nevus. Eye freckles are caused by clumps of melanocytes, or pigment-producing cells. Most often, no treatment is needed, and your doctor and eye care team will simply monitor the eye freckles for any changes.

However, if the spot turns out to be a type of cancer known as ocular melanoma, it will require treatment. This is a rare type of cancer, and treatment will likely consist of radiation, surgery, or immunotherapy.