Malignant melanoma is rare in West Africa. Few cases of giant melanoma have been reported globally. We present a case of acral melanoma with giant local recurrence on the foot of a black-skinned woman from rural Sierra Leone, managed with below-knee amputation. Atypical, late presentation, poor access to diagnostics, and underreporting may contribute to underappreciation of melanoma as a healthcare problem in West Africa. This case highlights the need for improved cancer and skin health surveillance structures in West Africa—most importantly, increasing access to histopathology.