BACKGROUND: Conjunctival melanoma (CM) is a rare and potentially aggressive malignancy of the ocular surface with high rates of local recurrence and metastasis. The objective of this report was to evaluate the yield of diagnostic staging tests in patients with conjunctival melanoma. METHODS: 81 consecutive patients with invasive conjunctival melanoma treated by the senior author over the course of 23 years were included. All imaging studies at baseline and during the follow up were reviewed. We also reviewed the yield of sentinel lymph node biopsy (SLNB) in patients who had this procedure as part of their baseline staging. RESULTS: We found an overall nodal metastatic rate of 16% and distant metastatic rate of 26%. The SLNB positivity rate was 23.1% (6 out of 26 patients).Eight out of 81 (10%) patients with CM had brain metastasis as identified on routine brain magnetic resonance imaging. CONCLUSIONS: More than a third of patients with nodal metastasis and most patients with distant metastasis, including 100% of patients with brain metastasis, were detected to have metastatic disease during the follow-up period, highlighting the importance of continued surveillance imaging. Twelve of 20 patients with distant metastasis (57%) never had nodal metastasis, highlighting the importance of continued surveillance for distant metastasis even with a negative SLNB result.