A 44-year-old woman complained of progressive nausea, vomiting, and increasing right upper quadrant pain. Approximately 1 month earlier, she had presented to the emergency department with a generalized tonic-clonic seizure. A computed tomographic scan at that time showed a left temporal hematoma and 2 hyperattenuated lesions located in the left thalamus and left caudate lobe; subsequent magnetic resonance imaging showed multiple hemorrhagic lesions throughout the brain that were worrisome for metastatic disease. Extensive evaluation was performed, and an abdominal computed tomographic scan showed a 2 × 5-cm lesion in the left lobe of the liver with some small scattered lesions of unknown significance. The hepatic lesion underwent biopsy with ultrasound guidance and was found to be a metastatic malignant melanoma; incidentally noted was the possibility of sludge or polyps on ultrasound examination of the gallbladder. The patient began treatment with whole brain radiation and high-dose interferon alfa-2a.