Twelve patients who were referred to the Oncology Service of Wills Eye Hospital, Philadelphia, with a pigmented epibulbar lesion that clinically resembled malignant melanoma of the choroid with extraocular extension were found to have other ophthalmic entities. The most common conditions that simulated extraocular extension of uveal melanoma were conjunctival malignant melanomas, which accounted for four of the 12 pseudomelanomas. Three of the 12 patients had staphylomas or scleral ectasis. Two of the 12 had subconjunctival hematomas. Senile scleral plaques, a presumed cellular blue nevus, and ocular melanocytosis accounted for the other three conditions. A thorough history, indirect ophthalmoscopy with scleral depression, ultrasonography, gonioscopy, and transillumination were helpful in distinguishing uveal malignant melanoma with extrascleral extension from other, often less serious, ophthalmic disorders.