In this study, the authors examine the survivorship of individuals who constitute the small subset of patients with Stage IV melanoma who present with their first and only detectable metastasis to the skeleton. One thousand two hundred six patients were identified with primary melanoma at the authors' institution since 1962. There were 14 patients with isolated (solitary) skeletal metastases. Survival was calculated by Kaplan-Meier technique. The survival rate for any individual with an isolated metastasis to the axial skeleton was 0. Three of 8 patients with melanoma metastases to the appendicular skeleton are alive at 18, 25, and 52 months after Stage IV detection. A statistically significant prolonged latency period (initial diagnosis to Stage IV) in the appendicular group compared with the axial group contributed to their significant survival rate advantage. The melanoma literature strongly supports the complete resection of soft tissue metastatic foci. These data support this concept and extend it to include isolated skeletal metastases. The mechanisms by which axial and appendicular skeletal metastases occur are significantly different. This difference manifests itself as a survival advantage for the appendicular group and warrants an aggressive surgical approach for these individuals.