In this issue of JAMA Ophthalmology, Larsen and colleagues1 performed a retrospective review of primary conjunctival melanomas; the cohort represented a 50-year retrospective assessment of specimens identified in the Eye Pathology Institute at the University of Copenhagen. The authors performed an analysis looking for BRAF mutation in all specimens when available. The main outcome measures included local and regional recurrences as well as melanoma-related mortality. The volume of cases in this report is impressive with 139 patients reviewed and a subset of 47 tumors analyzed for BRAF mutation. The study confirmed previous findings with regard to location—extrabulbar conjunctival melanomas are associated with the worst prognosis. The study did not identify or correlate tumor thickness, which has been identified as an important risk factor for regional spread. Nor did the authors address in depth the significance of primary acquired melanosis as a risk factor for development of frank melanoma. The latter are 2 very important features that surgeons should consider in their treatment strategy and stratification of high-risk patients.