Primary adrenal melanoma is a rare tumor. Most lesions are confined to the adrenal gland, without extension to surrounding structures. We report a primary adrenal melanoma discovered during an evaluation for pulmonary embolism. Tumor thrombus was present in the inferior vena cava extending into the right atrium. A complete resection was obtained using cardiopulmonary bypass and profound hypothermic circulatory arrest. Long-term survival with melanoma is still limited, regardless of the organ of origin.