A consecutive series of 450 eyes enucleated because of a malignant melanoma of the choroid or ciliary body was reviewed in an effort to establish the incidence of ocular inflammation or intraocular hemorrhage as the initial clinical manifestation. Thirty-five patients had these clinical signs initially. Twenty-two (4.9%) initially had ocular inflammations. Eight of these had an episcleritis, and the remaining 14 had some form of uveitis, endophthalmitis, or panophthalmitis. Five of those with episcleritis had tumors in the ciliary body, and all six patients who developed panophthalmitis had necrotic choroidal melanomas. Thirteen patients (2.9%) were initially observed with some form of intraocular hemorrhage. Follow-up information was available for 26 of the 35 patients selected for detailed study. Fourteen patients died of metastatic disease. We believe the relatively poor prognosis of these tumors depends on three factors: cell type, maximal diameter of the tumor, and extraocular extension.