Uveal melanoma metastatic to the liver remains an incurable disease. Unlike colorectal carcinoma metastastic to the liver, surgery is not considered a first-line approach because of the diffuse, multifocal nature of the hepatic metastases. Systemic chemotherapy and immunotherapy regimens have had minimal efficacy for patients with metastatic ocular melanoma. Hepatic artery chemoembolization has been explored to a limited degree, but reports of response remain anecdotal. Hepatic arterial infusion with fotemustine had an overall response rate of 38%, but the overall survival is still disappointingly short. Isolated hepatic perfusion is a promising technique for this disease. Although the reported response rate is more than 60%, isolated hepatic perfusion is associated with potential morbidity, and the number of patients treated by this means is still limited. Percutaneous hepatic perfusion has the potential for less morbidity, and its efficacy in this clinical setting warrants further evaluation. The conclusion of this review is that current treatment modalities need further refinement and new ones need to be developed to improve the outlook for patients with uveal melanoma metastatic to the liver. Unlike cutaneous melanoma, which metastasizes to numerous sites, uveal melanoma commonly metastasizes only to the liver. This underscores the importance of developing effective forms of liver-directed therapy.—Hans E. Grossniklaus