PURPOSE: To determine variations in 5-year relative survival rates with primary uveal melanoma in the United States over a 25-year period from 1973 to 1997. DESIGN: Systematic review of existing databases. PARTICIPANTS: Two thousand four hundred ninety-three patients with primary uveal melanoma, International Classification of Oncology [ICDO-2] codes C69.3 [choroid melanoma] and C69.4 [ciliary body and iris]) derived from Surveillance, Epidemiology, and End Results (SEER) program database in the United States from 1973 to 1997. METHODS: The patients were stratified according to the treatment (surgery or radiotherapy). The relative 5-year survival was calculated for 2054 patients diagnosed between 1973 and 1993 by the life table method using US life expectancy tables. MAIN OUTCOME MEASURES: The relative 5-year survival rate. RESULTS: Surgical treatment was performed in 1476 (72%) cases, and radiotherapy was given in 300 (15%) cases. The proportion of cases treated by radiotherapy increased progressively from 2% to 28% in 20 years. Relative 5-year survival rates ranged from 77% to 84% without a statistically significant variation. CONCLUSIONS: Advances made in the local methods of treatment of primary uveal melanoma have not led to an improvement in survival. Systemic approaches to management of uveal melanoma are warranted.