Metastatic uveal melanoma remains one of the most serious challenges facing patients diagnosed with this rare but aggressive eye cancer. While local control of the primary tumor is often successful, up to 50% of patients will eventually develop metastatic disease—most commonly in the liver. Until recently, however, there has been no standardized, evidence-based approach to post-treatment surveillance, leading to wide variation in care and uncertainty for patients and clinicians alike.
A newly published expert consensus study, Metastatic Uveal Melanoma Surveillance: A Delphi Panel Consensus, represents a significant step forward. Led by the Collaborative Ocular Oncology Group (COOG), this effort convened a multidisciplinary panel of ocular oncologists, medical oncologists, radiologists, and surgeons from across North America to establish risk-based surveillance recommendations using a modified Delphi method.
What makes this study especially impactful is its integration of modern molecular prognostic tools—specifically gene expression profiling (GEP) and PRAME status—alongside traditional clinical features. Prior guidelines have largely relied on tumor size and staging alone. In contrast, this consensus framework reflects current understanding that molecular markers provide superior risk stratification for metastatic uveal melanoma.
After three Delphi rounds conducted between September 2024 and February 2025, consensus was reached on 12 key statements addressing imaging modality, frequency, and duration of surveillance for intermediate- and high-risk uveal melanoma patients. The panel strongly favored contrast-enhanced MRI or CT of the abdomen over hepatic ultrasound, particularly for higher-risk patients, due to improved sensitivity for detecting early liver metastases. Routine PET/CT and laboratory testing were not recommended for standard surveillance, as they do not consistently improve detection.
Notably, no consensus was reached for low-risk patients, highlighting an important gap in the evidence. Experts expressed concern about over-surveillance in this group, given the low incidence of metastasis, potential harms from repeated imaging, and increased patient anxiety. This underscores the urgent need for prospective studies to better define optimal monitoring strategies.
For the ocular melanoma community, these consensus recommendations offer long-needed clarity. While they do not yet constitute formal clinical guidelines, they provide a standardized framework that can improve consistency in care, support earlier detection of metastatic disease, and better position patients to access emerging therapies—an especially important consideration as treatment options for metastatic uveal melanoma continue to evolve.