One hundred-seventeen radionuclide bone scans were performed on 46 patients with bilateral retinoblastoma between diagnosis and 19 years from diagnosis for the purpose of detecting skeletal metastases or other malignant neoplasms of bone that might develop in this group of patients at high risk for a second malignancy. Only one child, who had been symptomatic for 1.5 years, had a scan positive for metastasis at diagnosis. Scans in three additional children became positive (in one after the development of metastatic disease involving bone and soft tissue but not bone marrow 2 years after the diagnosis of retinoblastoma, and in two others after the development of osteosarcoma at 10.5 and 16 years from the diagnosis of retinoblastoma). Our data indicate that bone scans should not remain as part of the initial staging of patients with bilateral retinoblastoma unless there is clinical or pathologic evidence of extraocular disease at diagnosis. The performance of skeletal scintigraphy also is not warranted, with the expectation of diagnosing a second malignant neoplasm (namely osteosarcoma).