Due to hormonal and immunological changes, a paucity of conclusive literature, and other factors, managing melanoma during pregnancy is not a simple task. Additionally, when selecting treatment plans for patients who are pregnant, the risk of surgical intervention and anesthesia must be carefully evaluated.

We present a 27-year-old lady who was diagnosed with a T4 leg melanoma while carrying twins. Under spinal anesthesia, the patient underwent a wide local excision (WLE) and a video endoscopic inguinal lymphadenectomy (VEIL). The procedure went smoothly and had no negative consequences on the mother or the fetuses. The tissues' pathological analysis revealed persistent melanoma foci with clear surgical margins and no involvement of the inguinal lymph nodes at the tumor site.

This instance emphasizes the difficulties in treating melanoma in pregnant ladies and the value of using a multidisciplinary approach to select safe and efficient treatment modalities. To the best of our knowledge, this is the second case report of VEIL during pregnancy overall and the first case report of VEIL during twin pregnancy.