Uveal Melanoma Management: A Recent Review of the Literature

Uveal melanoma (UM) is the most common primary intraocular malignancy in adults and poses significant diagnostic and therapeutic challenges. Its management depends on tumor size, location, patient age, systemic health, and personal preferences. Traditional globe-preserving therapies include plaque brachytherapy and charged particle therapy, both of which achieve local control rates exceeding 90% for small- to medium-sized tumors. The Collaborative Ocular Melanoma Study (COMS) provided pivotal data, demonstrating equivalent mortality outcomes between brachytherapy and enucleation for medium tumors, while supporting enucleation for large tumors. Additional therapies such as transpupillary thermotherapy, photodynamic therapy, and local resection (endoresection or exoresection) can be used in specific scenarios or in combination to maximize tumor control while preserving vision. When tumors are large, display orbital extension, or are associated with severe complications such as intractable glaucoma, enucleation or exenteration may be required to safeguard patient comfort and survival. As adjuvant and neoadjuvant approaches evolve, multimodal regimens combining surgery, radiotherapy, and laser treatments are increasingly tailored to each patient’s unique clinical presentation. Close post-treatment surveillance and imaging are critical for early detection of recurrences and management of complications like radiation retinopathy, optic neuropathy, and cataract formation. This review highlights the recent advances, clinical considerations, and outcomes in UM treatment, emphasizing that individualized, multidisciplinary care remains central to optimizing both survival and vision preservation.