Aims Laryngeal metastases from malignant melanoma are rare, occurring in less than 0.5% of cases. Understanding their characteristics, diagnosis and treatment may aid early recognition and tailored management. Methodology From the Victorian state referral centre for melanoma, we report a rare case of a 72-year-old male with extensive, disseminated melanoma across the upper aerodigestive tract. We also conducted a literature review on the efficacy of various treatment options, especially with the rise of immunotherapy. Results The patient, referred for dysphagia and a tonsillar mass, had a history of scalp melanoma excision two years prior. Flexible nasoendoscopy (FNE) revealed widespread mucosa melanoma, up to 15 mm, throughout the postnasal space, bilateral tonsils, vallecula, epiglottis, arytenoids, post-cricoid space, and hypopharynx. Following multidisciplinary discussion, dual-agent immunotherapy was initiated with ipilimumab and nivolumab. Repeat FNE at one month demonstrated stability of the laryngopharyngeal disease. In literature, laryngeal melanoma is rare and predominantly involves the supraglottis due to its rich lymphatic network. Surgical resection may be considered for isolated metastases to alleviate symptoms, such as airway obstruction, but is seldom curative. Radiation therapy is typically palliative, while systemic therapies, including immunotherapy and targeted treatments (e.g., BRAF inhibitors), play a critical role in managing metastatic disease. The five-year survival rate for patients with distant melanoma metastases remains under 20%. Laryngeal involvement does not significantly alter this prognosis. Conclusion Laryngopharyngeal metastases from malignant melanoma, though rare, present a significant clinical challenge that requires prompt diagnosis and individualized treatment. Early identification and multidisciplinary management can enhance the patient’s quality of life by addressing severe symptoms and improving functional outcomes.