What is Uveal Melanoma Metastasis?
 

Uveal melanoma is the most common primary intraocular (eye) cancer in adults. Although it starts in the uvea (most often the choroid), it has a high risk of metastasis, even years after initial treatment.

Key Points:
 

• Metastasis rate:

  • About 50% of patients with uveal melanoma eventually develop metastases, despite successful local treatment of the eye tumor.

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• Most common site of spread:

  • Liver (in ~90% of metastatic cases)

  • Other possible sites: lungs, bones, and skin

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• Risk factors for metastasis:

  • Genetic mutations (e.g., BAP1 loss, chromosome 3 monosomy, chromosome 8q gain)

  • Tumor size, location (ciliary body tumors have higher risk), and cell type (epithelioid cells = worse prognosis)

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• Latency:

  • Metastasis can occur months to decades after initial diagnosis and treatment

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• Symptoms of metastasis:

  • Often related to liver involvement: fatigue, abdominal pain, weight loss, elevated liver enzymes

  • May be asymptomatic and found on routine surveillance

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• Surveillance:

  • Regular liver imaging (MRI or ultrasound) and liver function tests

  • No standardized protocol, but often every 3–6 months post-treatment

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• Treatment of metastatic disease:

  • No proven curative therapy once metastasis occurs

  • Options: clinical trials, liver-directed therapies (chemoembolization, radioembolization), immunotherapy, and targeted therapies (e.g., tebentafusp for HLA-A*02:01 patients)

  • Prognosis is poor: median survival is 6–12 months after metastasis, though newer treatments may extend life in some cases