Uveal melanomas are among the few cancers that are diagnosed clinically without a tissue diagnosis before treatment. The primary tumor poses few therapeutic challenges, but when metastases become apparent clinically, we still have little to offer patients. The prognosis was previously based only on clinical features. However, in recent decades, there has been tremendous progress in the understanding of tumorigenesis and tumor biology from the data obtained by a variety of sampling methods. This knowledge of chromosomal abnormalities, primary and secondary driver mutations, and tumor factors in the aqueous fluid and the general circulation are all used to predict which patients will develop metastases and when. In this chapter, we review recent advances in uveal melanoma prognostication. Moreover, it seems that not all metastases behave in the same fashion. Thus, we also touch on the prognostication of the metastatic disease itself.