# Metastatic Uveal Melanoma Surveillance: A Delphi Panel Consensus

## TL;DR

Experts developed standardized surveillance guidelines for uveal melanoma patients, incorporating genetic factors to improve detection of metastasis.

## Contribution

First consensus-based surveillance recommendations for uveal melanoma integrating genetic and molecular tumor characteristics.

## Key findings

- Twelve surveillance statements reached stable consensus among experts using a modified Delphi method.
- Recommendations include imaging modality, frequency, and duration for intermediate- and high-risk patients.
- No consensus was achieved on optimal surveillance strategies for low-risk patients.

## Abstract

Uveal melanoma is a rare but aggressive eye cancer that frequently spreads to distant organs, most commonly the liver, even after effective local treatment of the primary tumor. In the absence of standardized guidelines, current surveillance practices vary widely among physicians and institutions, creating uncertainty in patient care. To address this gap, our study convened a multidisciplinary panel of ocular oncologists, medical oncologists, radiologists, and surgeons from across North America to develop expert consensus recommendations for post-treatment surveillance. Notably, these recommendations are the first to incorporate genetic and molecular characteristics of the tumor, in addition to traditional clinical features, to guide risk-based surveillance strategies. This framework offers a standardized approach to monitoring, with the potential to improve early detection of metastatic disease and to serve as a foundation for future studies aimed at validating and refining surveillance practices in uveal melanoma.

Background/Objectives: Uveal melanoma is a rare but aggressive intraocular malignancy that metastasizes in up to half of patients, most commonly to the liver, despite effective local treatment. In the absence of robust evidence, there are no standardized guidelines for post-treatment surveillance, resulting in wide variation in imaging modalities, frequency, and duration across physicians and institutions. This study aimed to develop expert consensus recommendations for surveillance strategies in patients with uveal melanoma. Methods: A modified Delphi method was conducted across three iterative survey rounds between September 2024 and February 2025 using an online platform. Panelists included medical oncologists, ocular oncologists, radiologists, and surgical oncologists from North America. A multidisciplinary steering committee developed statements addressing risk-based surveillance using both molecular and clinical prognostic factors, including gene expression profiling (GEP) and PRAME status. Consensus was defined a priori as ≥70% of panelists rating a statement 7–9 on a 9-point Likert scale. Results: Forty-nine experts were invited, and 41 completed at least one survey round. The panel represented 17 U.S. states, Washington, D.C., and two Canadian provinces. Twelve statements reached stable consensus, including recommendations for imaging modality, frequency, and duration in intermediate- and high-risk patients. Although there was agreement that low-risk patients warrant surveillance, no consensus was reached on the optimal approach for this group. Conclusions: This is the first study to provide consensus-based guidance incorporating GEP and PRAME status into surveillance recommendations for uveal melanoma, offering a standardized framework to guide clinical practice and future research.