# Uveal melanoma prognostic markers (GNAQ/GNA11, monosomy 3, gene-expression class)

Source: https://onco.cc/terms/uveal-melanoma-prognostic-markers/  
OnCo record `uveal-melanoma-prognostic-markers` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Nearly all eye melanomas start with a mutation in GNAQ or GNA11, which is why skin-melanoma drugs do not work on them; what decides whether the tumour will spread to the liver is a second layer: loss of chromosome 3 with BAP1 mutation and a class 2 gene-expression profile mean high risk, while EIF1AX or SF3B1 mutations and class 1 mean low or delayed risk.

## Summary

What is measured: the driver and the metastatic risk of a uveal melanoma. How: fine-needle aspiration at the time of plaque brachytherapy or tissue from the enucleated eye, tested for GNAQ or GNA11 (about 90 percent; PLCB4 and CYSLTR2 in most of the rest; BRAF is absent), chromosome 3 and 8q status by FISH, MLPA or SNP array, a 15-gene expression profile (DecisionDx-UM class 1A, 1B or 2, with PRAME status adding risk), BAP1 immunohistochemistry or sequencing, and SF3B1 (late metastases) and EIF1AX (good outlook) mutations; AJCC size, ciliary body involvement and extraocular extension are combined in tools such as the Liverpool Uveal Melanoma Prognosticator Online. What a result changes: class 2 or monosomy 3 with 8q gain carries about a 70 percent risk of metastasis at five years against under 5 percent for class 1A, so it sets surveillance (liver MRI or ultrasound every six months for high risk) and eligibility for adjuvant trials (sunitinib, crizotinib, adjuvant tebentafusp in ATOM); HLA-A*02:01 typing decides tebentafusp in metastatic disease, the only drug with a survival benefit; MEK inhibitors and checkpoint inhibitors have low activity; PRAME-directed T-cell therapies (brenetafusp, IMA203) are in trials. Where it matters: uveal melanoma.

## Fields

- Kind: Term
- Last checked: 2026-09-17
- Also known as: GNAQ; GNA11; GNAQ/GNA11 mutation; monosomy 3; chromosome 3 loss; disomy 3; 8q gain; DecisionDx-UM; gene expression profile class 1; class 2 uveal melanoma; GEP class 1; GEP class 2; PRAME expression; EIF1AX; PLCB4; CYSLTR2; uveal melanoma genetics

## Connected records

- terms: [BAP1 loss](https://onco.cc/terms/bap1-loss/), [FISH / ISH (in situ hybridisation)](https://onco.cc/terms/fish/), [Gene expression](https://onco.cc/terms/gene-expression/), [HLA-A*02:01 restriction](https://onco.cc/terms/hla-a02-restriction/), [SF3B1 mutation](https://onco.cc/terms/sf3b1-mutation/)
- drugs: [Brenetafusp](https://onco.cc/drugs/brenetafusp/), [Tebentafusp](https://onco.cc/drugs/tebentafusp/)
- targets: [PRAME](https://onco.cc/targets/prame/)
- cancers: [Uveal melanoma](https://onco.cc/cancers/uveal-melanoma/)

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