The early lesions of bilateral diffuse melanocytic proliferation were studied with fluorescein angiography in a 63-year-old woman. We first observed a small choroidal melanoma in the left eye and several flat melanocytic lesions in both eyes. Extension and growth of new melanocytic lesions and leakage at the level of the pigment epithelium were then noted. Subsequently, pink patches, with an eye-catching early hyperfluorescence, appeared in the posterior fundus in both eyes. The patient experienced progressive visual loss during the 8-month follow-up period before her death. Histopathologically, the uveal tracts were diffusely thickened by melanocytic proliferation. The primary systemic neoplasm was an ovarian carcinoma, found in five of 18 patients with this unusual paraneoplastic syndrome.