Current management of uveal melanoma

Uveal melanoma is the most common primary malignancy of the eye and frequently leads to metastatic death. Until the mid-20th Century, the only treatment for uveal melanoma was enucleation. Since then, many new globe-sparing options have been developed, including plaque brachytherapy, charged particle radiotherapy, transpupillary thermotherapy, stereotactic radiotherapy and local resection. Despite these advances, it remains unclear what effect they are having on patient survival. Recent research has identified highly accurate molecular markers of metastasis and has provided new insights into the molecular pathogenesis of uveal melanoma. Based on these discoveries, a new treatment paradigm is emerging that combines prompt treatment of the primary tumor with molecular predictive testing and, eventually, prophylactic systemic treatment in patients at high risk of metastasis. Here, we present an update of the outcomes, indications and complications of the current treatment options for uveal melanoma and speculate on likely improvements in management over the next 5 years.