Malignant melanoma (MM) remains a pediatric rarity world-wide, but perhaps more 
so in black Africans. To the best of our knowledge, the current report of MM in 
a two-and-a-half-year-old Nigerian who had a pre-existing congenital giant hairy 
nevus is probably the first (in an accessible literature) in a black African 
child. Primary neoplastic transformation and metastatic spread were suggested by 
the appearance of multiple swellings over the "garment" precursor nevus at the 
posterior trunk, multiple ipsilateral axillary nodal enlargement, and fresh 
occipital swellings postadmission. Smaller-sized hyperpigmented lesions with 
irregular, nonlobulated, and frequently hairy surfaces were also discernible 
over the upper and lower extremities, but the face, anterior trunk, and mucosal 
surfaces were relatively spared. A diagnosis of MM was confirmed by the 
subsequent histopathologic findings from the fine-needle aspirate and biopsy 
specimens. Chemotherapy was initiated but was truncated shortly after by 
parent-pressured discharge. Despite the rarity of MM in a tropical African 
setting where management options are few, the current case underscores the need 
for a high clinical index of diagnostic suspicion, an early pursuit of 
investigative confirmation, and prophylactic excision in children with the 
predisposing skin lesions, like congenital giant hairy nevus. An expounded 
discourse of the possible precursors and management options of MM is provided. 
We emphasize the need for institutional cost subsidy for anticancer care in 
tropical children.