With the use of Immune Checkpoint Inhibitors (ICIs) and targeted therapies, the clinical outcomes of metastatic melanoma have drastically improved. The current scenario has reduced the use of chemotherapy as a first-line treatment. However, in a resource-limited setting, where access to ICIs and targeted therapies is not feasible, and in patients who fail to tolerate these therapies, chemotherapy continues to remain effective. The median survival and response rates with chemotherapy alone are dismally low. Here, we report a case in which a patient with stage IV anorectal melanoma was able to achieve a complete metabolic response and sustain it for 3 years and continue to do so with the first-line single-agent temozolomide.