DISCUSSION: Although melanoma confers a five-year survival rate of over 90%, patients with metastatic disease see their survival rates fall as low as 16.6%1. It is key for any cancer patient to receive adequate follow-up after initial treatment. In this case our patient did not have a regular medical follow up, causing delay in diagnosis of recurrence. Proper patient education is vital in aiding proper disease surveillance. Although metastasis to lung is found clinically in 18% - 36% of patients with metastatic melanoma, pleural melanoma is much rarer, with fewer than ten cases of primary pleural melanoma described since it was first reported in 19782. Very few cases of pleural metastatic melanoma have been reported, and are mostly limited to case reports. Pleural effusions are a very uncommon presentation of thoracic metastatic melanoma, seen only in 2% of those patients. The exudate can often be dark in color, due to the presence of melanin pigment in the fluid3.