Abstract
In uveal melanoma (UM), increased M2 macrophage infiltration and high tumor pigmentation are well-established adverse prognostic features, yet their biological interplay remains underexplored. Emerging evidence indicates that these characteristics frequently coexist in genetically high-risk tumors, particularly those with monosomy 3 and BAP1 loss. This commentary proposes that highly pigmented tumor cells and M2-polarised macrophages form an integrated, immunosuppressive tumor ecosystem that promotes immune tolerance and tumor progression. Recognizing immune–pigment coexistence provides a refined framework for prognostic assessment and highlights microenvironmental interactions as potential targets for future therapeutic strategies in UM. Understanding these dynamics may improve risk stratification and development of targeted therapies.