A 65-year-old white male with occasional photopsias is referred from an outside ophthalmologist for a pigmented lesion of his eye. The patient has an extensive cardiac history and a smoking history of 30 packs of cigarettes a year. Visual acuity, intraocular pressure, pupils and anterior segment exam are all normal for both eyes. Dilated fundus exam of the right eye is normal; the left eye is shown in the photos here. Ultrasound, both A- and B-scan, of the lesion revealed a solid lesion 20 x 17 x 8 mm with low internal reflectivity and no signs of extra-scleral extension.