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Background: Vertical transmission of maternal cancer cells to the child is extremely rare, but melanoma represents the most common culprit. The aim of this study is to determine individual risks for materno-fetal transmission of melanoma cells and to establish standardized procedures for pregnant melanoma patients and their offspring. Patients and methods: In this retrospective multicenter study, data on women with stage III or IV melanoma that had been diagnosed before, during or up to 12 months after pregnancy, were analyzed for the occurrence of metastases in the placenta or the infant. In addition, a literature search for previously described materno-fetal transmission in case of maternal melanoma was conducted. A historical patient group was established from these cases and a statistical analysis was performed (SAS, p < 0.05 significant). Results: In total, 67 children born to women with stage III or IV melanoma were included. No placental or infant metastases were detected in any of the cases. The additional literature search revealed 37 cases with placental metastases and 14 cases with infant metastases (6 of them overlapping). Of the affected children, 10 (71.43%) died from their disease. Maternal death shortly after birth seems to be an unfavorable factor for transmission to the infant. Conclusion: The risk of materno-fetal transmission of maternal melanoma metastases seems to be much lower than anticipated based on former studies. However, thorough placental screening and systematic follow-up of the children resulting from pregnancies of high-risk melanoma patients should be performed.