Each one of us, at one time or another, is confronted during a routine fundus examination by a small, flat, pigmented lesion, unassociated with any other abnormal fundus finding. Almost immediately several questions enter our mind: Could this be a very early malignant melanoma? If we can't be sure it's not a malignant melanoma, is it safe to wait and merely observe the patient periodically? If it is a benign lesion now, can it change into a malignant melanoma later on? It is the purpose of this paper to attempt an answer to these questions, especially the last one, based on a study of the clinical course of 42 patients possessing such a lesion. Let us first indicate specifically what kind of lesion we are concerned with in this paper. It is small, from a fraction of a disc diameter (Fig. 1) to several disc diameters in size (Fig. 2).