Hepatic metastasis surveillance in uveal melanoma: a retrospective cohort study from a UK tertiary centre (2006–2022)

BACKGROUND: Liver surveillance imaging is essential for detecting early asymptomatic metastases in uveal melanoma, which predominantly involves the liver. Early detection may improve treatment opportunities, but variability in imaging protocols and a lack of consensus on surveillance duration present challenges. This study aimed to evaluate our systemic surveillance protocol, optimise pathways, and assess risk factors for metastasis. METHODS: We retrospectively analysed patients diagnosed with uveal melanoma between 2006 and 2021 who underwent hepatic imaging surveillance at Sheffield Teaching Hospitals NHS Foundation Trust. Demographics, tumour characteristics, treatments, disease status, and survival outcomes were collected. RESULTS: Among 1086 patients (45% female, 79% White; median age 68 years), 315 (29%) developed metastases, with 293 (93%) detected within five years of ocular treatment. The number needed to scan (NNS) increased substantially after five years, indicating reduced detection efficiency. Higher T stage and ciliary body involvement were significantly associated with increased metastatic risk (P < 0.01). CONCLUSIONS: Most metastases from uveal melanoma occur within five years of treatment. Personalised, risk-based surveillance strategies considering tumour stage and location may improve efficiency and optimise healthcare resource use.