Choroidal melanoma is the most common primary intraocular malignancy in adults. 1 Several methods, including enucleation, 2-6 plaque radiotherapy, 7-18 charged-particle therapy, 19-22 local resection, 6,22-24 laser photocoagulation, 6,25-28 and even observation 3,29,30 are recommended for treatment of choroidal melanoma. Historically, enucleation was the standard method of treatment; however, because the advantage of enucleation in increasing patient survival has been challenged and recently proved to be noncontributory, 7,31-35 other globe-sparing therapeutic options have been advanced. The most frequently used treatment option is ionizing radiotherapy-brachytherapy, external beam irradiation using charged particles, or focused photon approaches. 7-22 Although radiation is effective in arresting tumor growth, it has been associated with numerous side effects, including dry eye, keratitis, cataract, radiation retinopathy and papillopathy, vitreous hemorrhage, glaucoma, and scleral necrosis. 10,[36][37][38][39][40][41] Laser photocoagulation using xenon arc, argon laser, and krypton laser have been used for the treatment of selected small choroidal melanomas. 26,41,42 In one study, the effects of xenon arc and argon laser photocoagulation of small choroidal melanomas were evaluated. 25 Recurrent tumor growth occurred in 14% of xenon arc-treated patients and 69% of argon laser-treated patients. Twelve and a half percent of patients treated with argon laser died of metastatic disease. It was postulated that argon wavelength laser energy is absorbed primarily by retinal pigment epithelium, and relatively little energy is absorbed by deeper structures. 25,41 Because photocoagulation as a primary therapy has limited usefulness, it has mainly been reserved as a supplement to plaque radiotherapy or for treating small recurrent tumors after radiotherapy. In this chapter, we discuss the future laser approaches for treatment of choroidal melanomas.