Choroidal melanoma is the most common primary malignant intraocular tumor with an annual incidence in the USA of 0.8 cases per 100 000 population.^[1] Once metastasis becomes clinically apparent, the 1-year mortality rate approaches 80%.^[2] Given this poor prognosis, enucleation was historically considered the only appropriate management for choroidal melanoma. However, in recent decades there have been many new developments in management, with a trend toward more conservative therapeutic methods. The impetus for this shift in paradigm was the proposition by Zimmerman et al^[3]that enucleation may in fact promote metastasis by intraoperative dissemination of tumor emboli. The transient rise in post-therapeutic mortality that prompted this theory has been validated over the ensuing 25 years, but is now believed to be attributable to prediagnosis and treatment micrometastasis in uveal melanoma. Therapeutic options …