AIM: To demonstrate the ultrasound biomicroscopic features of a ciliary body melanocytoma with extrascleral extension, and a conservative approach in its management. METHOD: Observational case reports. Two cases of ciliary body melanocytoma were suspected at presentation, confirmed histologically by biopsy, and subsequently monitored for change by serial ultrasound biomicroscopic imaging. The main outcome measures were anatomical and functional preservation of the eye, with avoidance of formal surgical excision. RESULTS: Ultrasound biomicroscopy allows clear visualisation of the tumours, and the ultrasound characteristic is of low homogeneous internal reflectivity. 5 year follow up with observation only demonstrates success with this conservative management approach. Histopathological evaluation confirmed melanocytoma. CONCLUSIONS: Melanocytoma is a rare tumour. However if considered in the differential diagnosis at presentation and confirmed histologically, further management with use of the ultrasound biomicroscope as an accurate mode of imaging is an acceptable technique for preservation of the eye and avoids surgical excision.