The name melanoma is confusing, as it has neither the word malignant nor the words “carcinoma, sarcoma, or blastoma” that indicate malignancy in common malignancies, but it is a real malignancy. Many people now understand that some moles can be malignantly transformed into melanoma, and they have heard about the great progress made in immunotherapy for melanoma. However, many people do not know that melanoma is also a malignant tumor that can easily metastasize to the brain. Moreover, melanoma metastasis to the brain is not completely untreatable; some patients with melanoma metastasis to the brain have a chance of prolonging their lives with surgical resection. Mr. Wu is almost 60 years old, and 3 years ago, he went through a series of treatments such as surgery, cryotherapy, radiotherapy, chemotherapy, anti-vascular targeted therapy and PD1 antibody immunotherapy because of melanoma in the oral cavity, and Mr. Wu’s status has been good. However, recently, his family found that he suddenly showed signs of unstable walking and slurred speech, and a relatively large tumor in the right temporal lobe was found through MRI of the head. Soon, the patient went into a shallow coma, because the cause of Mr. Wu’s coma was the increased intracranial pressure and brain herniation caused by the melanoma metastasis to the brain combined with hemorrhage, which would soon be life-threatening if it continued to develop, and emergency surgery was necessary to remove the tumor to save his life. Sure enough, because of the timely surgery, Mr. Wu woke up soon after the surgery to remove the tumor and returned to the biotherapy department to continue immunotherapy. The progress of melanoma in immunotherapy and other aspects is also the result of recent years, before that, the treatment effect of melanoma was much worse. Moreover, once brain metastases appear, the tumor grows fast and radiotherapy is ineffective, the disease progresses even more rapidly. In the past, it was thought that there was little hope for treatment in this case, so intervention through invasive surgery was rarely done, and the patient was waiting for a rapid path to death. Moreover, because of the short survival time of melanoma patients, many may be at the end of their lives even before intracerebral metastases occur. However, with advances in treatment technology, the survival time of this group of melanoma patients is significantly longer, and accordingly, the chances of detecting brain metastases are much higher. At the same time, with the development and advancement of neurosurgical techniques, removal of metastatic melanoma in the brain is mostly a safer procedure. Therefore, for this type of melanoma that is solitary and has a severe increase in intracranial pressure due to tumor compression of brain tissue, surgical removal of solitary metastatic tumor is a most direct and effective and relatively safe treatment method. Of course, not all melanoma metastases in the brain need to be removed surgically, and if the metastases to the brain are relatively small, surgery is not necessary for the time being. Also, not all melanoma metastases to the brain can be treated by surgical resection, and surgical resection is not useful for multiple extensive brain metastases.