Bladder melanosis is a rare and poorly understood condition involving melanin pigmentation within the urothelial mucosa. Cases often present with haematuria, urinary obstructive symptoms, or cystitis. While generally considered benign, its potential association with malignancy warrants regular monitoring, as cases have previously been reported of an association with urothelial carcinoma and melanoma, although it is unclear whether there is a causal relationship. Here, we present the case of a fit and well 51-year-old male who was diagnosed incidentally with bladder melanosis following cystoscopy and perform a thorough literature review of all known cases.