UMs carry mutually exclusive activating mutations in GNAQ, GNA11, PLCβ4, and CYSLTR2, encompassing more than 90% of UM patients.4,19, , -22 Bidard et al18 detected ctDNA in 84% of patients with UM with metastatic disease and found ctDNA levels to be an independent prognostic factor for both progression-free survival and overall survival.18 However, the presence and prognostic significance of ctDNA in patients with primary UM without detectable metastatic disease has yet to be evaluated. Here, GNAQ is linked to metastatic neoplasm.