Infraclavicular nodal metastases are a described but uncommon pattern of lymphatic dissemination in upper limb melanoma, often facilitated by the classically described Mascagni-Sappey pathway. We present an electic case where such a metastasis occurred in close association with a cardiac pacemaker lead, Case: An 82yo male presented with PET and biopsy proven left infraclavicular nodal melanoma, background of resected stage IIIB melanoma 2 years prior- a left forearm primary 3mmBT superficial spreading melanoma (non-ulcerated, 0 mitoses, BRAF wild-type) with a positive epitrochlear (4mm melanoma deposit), but negative axillary sentinel lymph node biopsy, for which he was managed with adjuvant nivolumab- during which the nodules were clinically detected. This was on a background of having nocardia myocarditis in 1969, for which the patient was pacemaker dependant- having had a left sided pacemaker for over 50 years, of which the wires were closely associated with the metastases. Management consisted of placement of a right sided new pacemaker, with a concurrent deactivation the left. Consideration was given to ipsilateral pacemaker removal at time nodal resection, however this was ultimately decided against due to complex instrumentation required and risk of systemic spread. 3x metastatic deposits were resected without complication, a clear plane between the prosthesis. Patient was on-referred for consideration repeat immunotherapy +- radiotherapy, as well as elective pacemaker removal after a disease free period