The long-term follow-up results were reported on 23 patients who underwent internal surgical resection between 1984 and 1991 for presumed posterior choroidal melanoma. The melanomas were located within 1- to 2-disc diameters of the disc or the fovea. Follow-up ranged from 7 to 84 months with 57% of the patients followed for more than 4 years. Final Snellen visual acuities varied from 20/40 to no light perception; 43% of the patients attained 20/400 or better. Two patients required enucleation; one had intraocular tumor recurrence and subsequently died of liver metastasis, and the other patient developed a blind, painful eye secondary to retinal detachment with proliferative vitreoretinopathy. Three of the 23 patients have died of choroidal melanoma metastatic to the liver at 15 months, 57 months, and 84 months following internal resection, respectively. Two of the 3 patients had spindle B-cell tumors and one had a mixed cell tumor.