Four patients, each with a history of choroidal melanoma for more than ten years, became increasingly proptotic secondary to massive extraocular extension of their tumors. Because no metastases were detected during thorough systemic examinations, two patients underwent orbital exenteration. These patients suffered fulminant local orbital regrowth of their tumors at three and six months after surgery and died of distant metastases within ten months of exenteration. A third patient, who underwent a biopsy of the orbital mass via a lateral orbitotomy and received postoperative radiotherapy, died two years afterward. A fourth patient who refused any surgical treatment was followed up for five years after massive orbital disease developed. She died of disseminated disease. The patients who survived the longest had minimal or no surgery.