Fig. 1

Posterior uveal melanoma prognostic test flow-chart. Because the current prognostic tests rely on either DNA or RNA extraction from tumor specimens. Tumor tissue procurement should be done ideally prior to any form of local destructive treatment that may alter the DNA and/or RNA of the tumor cells (including radiation). Tissue can be obtained from either an enucleation specimen that has been formalin-fixed and paraffin-embedded (FFPE) or a fine needle aspiration biopsy (FNAB) of the tumor prior to conservative treatment or immediately after enucleation. FFPE scrapings from an enucleation specimen can be sent for DNA extraction and can allow for further analysis of the tumor through karyotyping, FISH (fluorescence in situ hybridization), CGH (comparative enomic hybridization), MLPA (multiplex ligation-dependent probe amplification), or GEP (gene expression profiling). Through FNAB, small quantity of fresh tumor cells is extracted from the tumor. These cells can be sent for cytology, GEP, or MLPA. GEP relies primarily on RNA extraction from these cells but it can also be performed using DNA. MLPA relies solely upon DNA extraction. GEP stratifies tumors into Class 1A, Class 1B, or Class 2 based 12 discriminating genes and 3 control genes. MLPA yields a complex report describing risk stratification of the test that includes the genetic information yielded, clinical features of the tumor, and patient demographics. Estimated 10-year metastasis-free survival is listed based on publications on karyotype analysis [9], FISH [12], MLPA [13]. Estimated 5-year metastasis-free survival based on GEP classification is also listed [7]