Melanoma is a highly aggressive malignant neoplasm, with uveal melanoma being the most common primary intraocular malignancy in adults, accounting for 3–5% of all melanoma cases. While liver metastases are clinically detectable in 10–20% of patients with metastatic disease from cutaneous melanoma, uveal melanoma primarily metastasizes to the liver, with approximately 87% of patients with metastatic uveal melanoma developing liver lesions. These metastases often remain asymptomatic in the early stages, making early detection challenging. In this report, we present the case of a patient who presented to our ultrasound unit with a significant liver mass. Initial imaging studies, including contrast-enhanced abdominal computed tomography and magnetic resonance imaging, were inconclusive in providing a definitive diagnosis. Given the clinical context and the need for further evaluation, an ultrasound-guided biopsy of the liver mass was performed. This procedure was crucial in establishing the diagnosis, confirming the presence of uveal melanoma metastasis. The ultrasound-guided biopsy proved to be an essential tool in accurately diagnosing liver metastases in this case, underscoring its significance in the management of patients with melanoma. Following the case presentation, we provide a literature review focusing on the imaging follow-up of melanoma patients, emphasizing the role of various imaging modalities in monitoring disease progression and response to treatment. This case highlights the importance of ultrasound-guided biopsy in the diagnosis of liver metastasis, particularly in the context of uveal melanoma, and calls attention to the need for vigilant surveillance in high-risk patients.
