Uveal melanoma: innovations in therapy, prognosis, and imaging

INTRODUCTION: Uveal melanoma (UM) is the most common adult primary intraocular malignancy with local tumor control exceeding 95%, while ~50% of patients still develop metastasis. Advances in diagnostic tools, therapeutics, and prognostication guide individualized care and support a shift toward precision medicine. AREAS COVERED: This narrative review covers advances in imaging, therapy, and prognosis. Literature was identified through searches of PubMed, Embase, Google Scholar, and ClinicalTrials.gov through August 2026, supplemented by reference lists and clinical practice guidelines. Topics include imaging advances in optical coherence tomography (OCT), ultrasonography, and lesion classification using artificial intelligence (AI); globe-preserving local therapies, systemic T-cell-based therapies, targeted therapies, checkpoint inhibitors, and liver-directed approaches; and prognostic tools based on gene expression profiling, preferentially expressed antigen in melanoma (PRAME), cytogenetics, and circulating tumor DNA. EXPERT OPINION: The clinical approach to UM is evolving rapidly, with more clinical trials than ever. Advances aim to improve early detection and preserve vision while controlling the primary tumor, and the first US Food and Drug Administration-approved therapies offer incremental improvements in survival for patients with metastatic disease. Imaging-based AI may support earlier detection, while collaboration between clinicians and laboratory scientists remains essential to improving survival.