Practical algorithm
2026 algorithm: integrating decisions in uveal melanoma
The quality of a decision depends less on the number of methods than on how they are integrated into a personalised pathway.
For patients and clinicians
Decision pathway
1Local control
Control of the primary tumour.
2Risk
Clinical + molecular risk.
3Surveillance
Risk-adapted liver-focused imaging.
4Metastatic node
HLA + anatomy + tempo + ECOG/LDH.
5Systemic
Tebentafusp for appropriate HLA-A*02:01+ disease; ICI with evidence limitations in mind.
6Liver-directed
According to pattern and technical feasibility.
7Reassess
Clinical status + imaging + next opportunity.
8Trial / referral / Ukraine
Verify real availability.
Ukraine: access to specific drugs and highly specialised technologies requires current verification.
Key references
- Piperno-Neumann S, et al. ESMO-EURACAN Clinical Practice Guideline. ESMO Open. 2026.
- Hassel JC, et al. Three-year overall survival with tebentafusp. N Engl J Med. 2023.
- Pelster MS, et al. Nivolumab + ipilimumab in metastatic UM. J Clin Oncol. 2021.
- FDA. Melphalan/Hepatic Delivery System for hepatic metastases from uveal melanoma. 2023.