• One hundred twenty-six surgically excised pigmented lesions of the conjunctiva were evaluated and correlated with clinical data and follow-up information. Of these, 42 were classified as conjunctival melanomas, with 18 arising apparently de novo, 15 from acquired melanosis, and nine from nevi. The six tumor deaths occurred only in patients with melanomas arising de novo or from acquired melanosis. Patients with tumor deaths usually demonstrated local recurrences long before metastases occurred. Moreover, several patients had local recurrences treated repeatedly for years without metastatic spread. Recent clinical findings relating to skin melanomas were applied and evaluated.