Uveal Melanoma Liver Metastasis: Follow-Up Scans and Treatment Options

After treatment for eye melanoma, a new question comes up: could the cancer appear somewhere else? The place to watch is the liver, because this melanoma spreads through the blood. That is why liver scans continue for years, and why it helps to know today's treatment options in advance.

Why does uveal melanoma spread to the liver?

The inside of the eye has no lymph vessels. Melanoma cells that leave the eye therefore travel in the blood and settle mostly in the liver. The lungs, bones and skin are affected less often.

At diagnosis, spread is found in only about 2–3 people in 100, but it can appear years later. Your own risk depends on the size, position and genetic profile of the tumor; see prognosis and genetic testing.

How often do you need liver scans after eye melanoma?

The 2026 guidelines of the US National Comprehensive Cancer Network set the schedule by your risk of spread:

The risk group depends on the size and position of the tumor and, after a biopsy or removal of the eye, on its genetic profile. The scan can be a liver MRI with contrast dye, a CT scan or an ultrasound of the abdomen, sometimes with a chest scan. MRI uses no X-rays, which matters when scans go on for years.

Blood tests for tumor DNA (a "liquid biopsy") are being studied as a way to find spread earlier, for example in the ATOM trial. As of September 2026 they do not replace scans.

Three habits make follow-up more reliable, especially if you live far from your treating center.

What happens if a scan shows a new spot?

A new spot on a liver scan is not always a metastasis; more imaging or a biopsy may be needed. If spread is confirmed, a team of specialists usually reviews your case together. One of the first steps is a blood test for your HLA type, because it determines whether tebentafusp can be used. Other choices depend on how much of the liver is involved, whether there is disease elsewhere, your general health and the trials that are open.

How is uveal melanoma liver metastasis treated?

The main options and their status as of September 2026:

Tebentafusp (Kimmtrak)

Tebentafusp is a protein with two arms. One arm recognizes a marker that melanoma cells display with the help of HLA-A*02:01; the other steers the body's own T cells (immune cells) against the tumor. It therefore works only in people with this tissue type, about half of patients with metastatic uveal melanoma.

In the phase 3 trial that led to approval, 378 previously untreated patients received tebentafusp or another drug chosen by their doctor. Median survival is the point at which half of the patients are still alive. In the first analysis, it was 21.7 months with tebentafusp and 16.0 months with the other drugs. Five-year results published in 2026 showed 16% of patients alive with tebentafusp and 8% with the other drugs.

It is given as a weekly infusion into a vein. Most people (89%) develop cytokine release syndrome, an inflammatory reaction of the whole body, usually with the first three doses. It is severe in fewer than 1 in 100, but each of the first three infusions is followed by at least 16 hours of monitoring in the hospital. Rash and itching (91%) and raised liver enzymes (65%) are also common.

Darovasertib plus crizotinib (not yet approved)

Both drugs are taken by mouth and block two growth signals that uveal melanoma cells depend on. In a large trial of 313 previously untreated people without HLA-A*02:01, the combination held the disease back longer than immunotherapy. Median time before the cancer grew again was 6.9 months, compared with 3.1, and tumors shrank in 37% of people, compared with 6%. Survival results were not yet final.

A submission to the US FDA began in May 2026. As of September 2026 the combination is not approved and is available only within clinical trials.

Immune checkpoint inhibitors

These drugs release a brake on the immune system, but in uveal melanoma they work much less well than in skin melanoma. Used alone, they have historically given a median survival of roughly 7–10 months. Ipilimumab plus nivolumab did better in a study of 35 patients: 18% responded and median survival was 19.1 months. However, 57% had severe side effects (40% related to the treatment). The combination remains an option, especially for people who cannot receive tebentafusp.

Treatments directed at the liver

Because the liver is often the only place the disease has reached, treatments aimed at it matter.

Melphalan liver perfusion (Hepzato Kit) delivers a high dose of the chemotherapy drug melphalan straight to the liver. The blood leaving the liver is filtered to limit the drug's effect on the rest of the body. In the main study of 91 treated patients, 36% responded and the disease was controlled in 74%. Median time before the cancer grew again was 9 months, and median survival 20.5 months. Serious side effects included low platelets (16%) and low neutrophils (11%), a kind of white blood cell. The FDA label warns of serious complications around the procedure and low blood counts, and only certified centers may give it.

In selected patients, surgery can remove a few liver metastases. Some specialist centers also offer ablation, which destroys a small tumor in place, or radioembolization and chemoembolization, given through the liver's blood vessels. Results vary between centers and patient groups. Radiotherapy can treat a few metastases or ease symptoms.

Can treatment after eye therapy prevent spread?

Not yet. No drug has been proven to prevent spread once the eye tumor has been treated. The standard is still regular scans based on your risk, or a clinical trial. As of September 2026, two phase 3 trials are testing this idea in people at high risk.

• ATOM, led by a European cancer research organization, compares up to six months of tebentafusp with observation. It plans to enroll about 290 people with HLA-A*02:01 in 13 countries; the first patient entered the trial in December 2024. The trial also studies tumor DNA in the blood as a sign of remaining disease.
• OptimUM-11 compares 12 months of darovasertib plus crizotinib with observation in about 450 patients of any HLA type. The first patient joined in September 2026.

In this setting both treatments are investigational and available only within these trials.

What helps during years of follow-up?

Years of scans can be stressful, especially in the days before a result. It can help to agree in advance how results will reach you, to keep all reports and images in one folder and to bring a family member to appointments. Patient organizations such as the Ocular Melanoma Foundation and CURE Ocular Melanoma offer information, support groups and help with finding trials.

Eye follow-up in Antalya, Turkey

The treated eye still needs regular checks for tumor control and radiation effects. Problems such as radiation damage to the center of the retina (radiation maculopathy) or a cataract can often be treated.

If you live abroad, the liver scans done at home can be sent for review, and eye visits in Antalya can be planned around your travel. See the international patients page and the main page on uveal melanoma treatment.