A 60-year-old Caucasian male presented to our urology clinic with a chief complaint of gross hematuria. The patient's medical history was significant for a diagnosis of malignant melanoma of the left distal thigh in 2003, which was treated with wide local excision, sentinel node biopsy, and left groin dissection. A positron emission tomography scan in 2007 showed increased lymph node activity in the neck, along with retroperitoneal and left inguinal lymphadenopathy. In 2008, he underwent isolated limb perfusion with melphalan and actinomycin D, and demonstrated a partial response. After being lost to follow-up, he returned to our hospital system in 2014 with metastatic melanoma, with a Clark III pectoral lesion along with a new brain lesion. He was started on pembrolizumab treatment to which he showed a partial response. In 2015 he presented to the urology clinic with a one-and-a-half-month history of painless gross hematuria. Cystoscopy showed a 2 cm papillary tumor in the left lateral wall of the bladder and it was fluorescent under hexaminolevulinate acid with blue-light cystoscopy (HAL-BLC). After a successful transurethral resection of bladder tumor (TURBT) of the lesion, he received 40 mg of intravesical mitomycin-C postoperatively. Pathologic review of the specimen along with histochemical analysis using melanoma-specific stains, S-100 () and melanocytic antigen recognized by cytotoxic T lymphocytes (MART-1) (), supported a diagnosis of metastatic melanoma of the bladder. The patient is still alive and continues to seek care at a tertiary medical facility.