Primary melanotic tumors of the central nervous system encompass a wide variety of lesions with clear differences in features and treatment options. The cellular origin of pigmentation and pigmented lesions is melanocytes. These normal cells are derived from the neural crest and are dispersed in the leptomeninges with a concentration in the posterior fossa and upper spinal cord locations. Melanotic tumors of the central nervous system can be considered as primary or secondary. The majority of secondary tumors result from metastasis of systemic melanoma. Primary melanotic tumors include melanocytomas and primary melanomas which range in behavior from benign to malignant. A subset of meningiomas, medulloblastomas, and schwannomas may also be pigmented and considered as melanotic. In this review, we present clinical, radiographic, pathological, and treatment considerations for these rare tumors. © 2012 by John Wiley & Sons, Inc.