Melanoma is the most deadly of skin cancers, and metastatic disease most commonly first appears in the lungs. Because most patients with early metastatic pulmonary disease are asymptomatic, routine screening with chest radiographs is the most cost-effective method of discovery. The therapy for pulmonary metastatic melanoma has drastically changed over the years. Even today there is no curative immunotherapy or chemotherapy available. The long-term overall survival for these patients is still very poor, but early detection and surgery offers the only hope for control in a small number of patients.