Systemic treatments for metastatic uveal melanoma patients give poor results. R0 resection of liver metastases showed a real benefit in survival in a very highly selected population. Based on our multivariate analysis, we propose surgical treatment to metastatic patients with time from diagnosis of uveal melanoma to liver metastases > 24 months, number of liver metastases ≤4 lesions, and absence of detectable miliary disease. Liver MRI is currently the best imaging method in this context even if miliary disease is still difficult to diagnose. Molecular and chromosomal classification strongly predicting metastatic death has to be used to identify genetic profiles and pathways involved in the pathogenesis of uveal melanoma leading to new targeted therapeutic strategies.