VERY-RARE CANCEREye CancerWHO 5th Edition Classification

Uveal Melanoma

Very Rare Malignancy (1–5 cases per 1,000,000 / year) • Clinical Staging, Genomic Targets & Vetted Specialists

The commonest primary eye cancer in adults, arising from pigment cells of the choroid, ciliary body or iris. It is biologically distinct from skin melanoma - different drivers, no BRAF V600E, and a strong tendency to spread to the liver, sometimes many years after the eye has been successfully treated.

Emergent Referral AdvisoryImmediate Action

Certain rare malignancies progress rapidly or carry acute risk of airway obstruction, acute spinal compression, hydrocephalus, or biopsy-seeding. Do not perform needle biopsy or surgery outside of an NCI-designated specialty sarcoma or neuro-oncology unit without multidisciplinary tumor board review.

Report immediately to an emergency department or tertiary oncologist upon:

  • Lifelong liver surveillance is required - metastasis can occur 10+ years later
Who It Affects

Adults, median around 60; light iris colour is a risk factor

Annual Incidence

Approximately 5-6 per million per year

Clinical Evidence Review

Last audited: 2026-08-13 against NCCN, ESMO, and WHO 5th ed. guidelines.

Clinical Presentation & Hallmark Symptoms

Presenting signs most frequently observed across clinical case series

Blurred vision or a shadow in the field of vision
Flashing lights or floaters
A dark spot on the iris that is enlarging
Change in pupil shape
Frequently asymptomatic and found on routine optometry

Genomic Profiling & Defining Molecular Lesions

Critical diagnostic fusions, somatic mutations, and therapeutic targets

Rare malignancies frequently depend on distinct oncogenic drivers rather than conventional environmental carcinogens. Comprehensive Next-Generation Sequencing (NGS comprehensive panel) and FISH/IHC are mandatory to establish the true diagnosis and screen for basket trial agents.

GNAQ / GNA11BAP1 loss - high metastatic riskSF3B1EIF1AX - low riskMonosomy 3

Standard-of-Care Treatment Protocol

Frontline and multimodal strategies established under international consensus guidelines

1

Plaque brachytherapy - the commonest eye-preserving treatment

Administered in specialized high-volume oncology programs with subspecialty pathology and organ-preservation protocols.

2

Proton beam radiotherapy for larger or posteriorly located tumours

Administered in specialized high-volume oncology programs with subspecialty pathology and organ-preservation protocols.

3

Enucleation for large tumours or when vision is already lost

Administered in specialized high-volume oncology programs with subspecialty pathology and organ-preservation protocols.

4

Tebentafusp for HLA-A*02:01-positive metastatic disease

Administered in specialized high-volume oncology programs with subspecialty pathology and organ-preservation protocols.

5

Liver-directed therapy - hepatic perfusion, embolisation - for liver-limited spread

Administered in specialized high-volume oncology programs with subspecialty pathology and organ-preservation protocols.

6

Prognostic biopsy with gene expression profiling to guide surveillance intensity

Administered in specialized high-volume oncology programs with subspecialty pathology and organ-preservation protocols.

Clinical Trial Advisory: For rare and ultra-rare malignancies, enrollment in an active clinical trial or expanded-access program is widely considered the preferred standard of care by ASCO and NCCN panels.

Prognosis & Disease Trajectory

Objective clinical outlook without false reassurance

Local eye control is achieved in over 90% of cases, but roughly half of patients eventually develop metastases, overwhelmingly hepatic. Monosomy 3 and BAP1 loss identify the high-risk group. Tebentafusp is the first therapy to show an overall survival benefit in metastatic disease.

Note: Statistics reflect cohort averages. Individual outcomes depend heavily on performance status, resectability, biomarker expression, and timely access to specialized tertiary care.

Active Research, Biomarkers & Clinical Trials

Novel investigational agents, phase I/II trials, and international rare disease consortia

Tebentafusp in earlier lines, HLA-agnostic ImmTAC agents for the HLA-A*02:01-negative majority, and liver-directed combinations are the principal areas of development.

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Expert Clinicians

Verified Specialists for Uveal Melanoma

Browse All Oncologists

Dr. Takami Sato

Medical Oncologist

30+ yrs exp

Jefferson Hospital

Philadelphia, USA

Uveal MelanomaHepatic PerfusionClinical Trials
Vetted DirectoryConsult Specialist

Dr. Adrian Tan

Senior Consultant Ophthalmologist

20+ yrs exp

SNEC

Singapore, Singapore

Ocular OncologyUveal MelanomaPlaque Brachytherapy
Vetted DirectoryConsult Specialist

Prof. Sarah Coupland

Ocular Pathologist/Oncologist

25+ yrs exp

University of Liverpool

Liverpool, United Kingdom

Ocular OncologyUveal Melanoma ResearchOcular Tumors
Vetted DirectoryConsult Specialist

Dr. Santosh Honavar

Ocular Oncologist

25+ yrs exp

LV Prasad Eye Institute

Hyderabad, India

Ocular OncologyUveal MelanomaPlaque Radiotherapy
Vetted DirectoryConsult Specialist
Hospital Network

Designated Cancer Centers with Dedicated Programs

Search All 72 NCI Centers

NCI-Designated Comprehensive Cancer Center

World-leading rare tumor board & pediatric solid tumor protocols

Proton TherapyCAR-T Cell TherapyRobotic Surgery
1,000+ Active Clinical TrialsView Center Profile

NCI-Designated Comprehensive Cancer Center

Largest specialized rare cancer and sarcoma multidisciplinary program

Proton TherapyCAR-T Cell TherapyCyberKnife SBRT
1,200+ Active Clinical TrialsView Center Profile

NCI-Designated Comprehensive Cancer Center

Pioneering genomic molecular tumor boards & rare histologies

Proton TherapyCAR-T Cell TherapyPhase I Unit
1,100+ Active Clinical TrialsView Center Profile

NCI-Designated Comprehensive Cancer Center

High-volume surgical oncology & rare endocrine/neuroendocrine expertise

Proton TherapyCAR-T Cell TherapyCyberKnife SBRT
600+ Active Clinical TrialsView Center Profile

Frequently Asked Clinical Questions

Authoritative guidance on diagnosis, tumor boards, genomic markers, and care options

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Independent Tumor Board Review

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