Molecular Prognostic Testing and Individualized Patient Care in Uveal Melanoma

PURPOSE: To critically assess the status of molecular prognostic testing and its use for individualized patient care in uveal melanoma. DESIGN: Perspective, literature review, evidence assessment, and commentary. METHODS: Evaluation of selected articles from the literature and the authors' clinical and laboratory studies. RESULTS: The most accurate molecular tests for predicting metastatic death in patients with uveal melanoma currently involve automated techniques for assessing deoxyribonucleic acid (DNA) copy number alterations and gene expression profiling. Most tests reported in the literature to date do not provide adequate scientific and statistical validation to be used outside of an ethically supervised investigational environment. CONCLUSIONS: Many cytogenetic and molecular prognostic tests for uveal melanoma have been reported, yet few have reached the standards required for routine clinical testing. Clinicians must understand the statistical and scientific limitations of the tests they are using, and appropriate ethical oversight is essential until such time that validated testing instruments are available that are performed in a standardized clinical testing environment. Well-controlled prospective studies are necessary to identify the most accurate, widely accessible, and affordable tests for routine clinical use. (Am J Ophthalmol 2009; 148: 823-829. (C) 2009 by Elsevier Inc. All rights reserved.)