This patient was seen in 1985 at age 66 with a pigmented flat iris lesion on his left eye. He was not seen again until 23 years later at age 89 when this mass had grown to the size seen here. His intraocular pressure had required three medications to keep it in a normal range. On ultrasound the mass extended 3 mm above the iris plane. Interestingly his referring physician had done a phacoemulsification three years earlier and, on ultrasound, the haptic of the IOL appeared to be engulfed in tumor. The patient refused enucleation and had radiation plaque therapy performed.