A 60-year-old Caucasian male presented to his primary care physician in January 2017 with the chief complaint of blurry vision in his right eye, sinus pressure, and dizziness for three weeks….Tissue examination of a CT-guided L3 lesion biopsy revealed malignant cells consistent with melanoma....Further genetic analysis of the vertebral biopsied tissue identified a GNAQ/11 mutation....Due to concern of increased toxicity from dual ICI, the patient resumed single-agent nivolumab in October 2020. From October 2020 to January 2021, serial imaging continued to show a positive response to immunotherapy with complete regression of liver lesions and stable pulmonary nodules.