Thirty percent of melanoma patients develop metastases, particularly in the central nervous system (CNS), following primary tumor removal, yet large-scale database studies on CNS metastasis risk factors are lacking. We queried the Nationwide Emergency Department Sample from the last quarter of 2015 to 2019 for melanoma patients presenting to the emergency department (ED) with a primary diagnosis of CNS metastasis. Multivariate logistic regression was used to identify factors associated with a significant risk of developing CNS metastasis. In this time period, 95,875 melanoma patients presented to the ED and 6.2% had at least 1 CNS metastasis. Most CNS metastasis patients were male (69.4%), at least 65 years of age (49.0%), Medicare beneficiaries (48.6%), and of the 3rd income quartile (27.7%) Most of these patients presented to hospitals in the South (40.3%), of a non-trauma status (40.7%), and with a metropolitan teaching status (77.1%). The following factors were associated with increased odds of developing a CNS metastasis: 21-44 years of age (odds ratio (OR): 1.46, p=0.003), 45-64 years of age (OR: 1.37,p=0.001), private insurance owners (OR: 1.39, p=0.001), Trauma Level I hospital (OR: 1.75, p<0.001), Trauma Level II hospital (OR:1.41, p=0.002), and metropolitan teaching hospital (OR: 1.29,p=0.017). Factors associated with a decreased risk of developing a CNS metastasis are the following: female sex (OR: 0.69, p<0.001) and non-metropolitan teaching hospital (OR:0.52, p<0.001). Hospital and patient factors influencing the risk of CNS metastases development in melanoma patients, emphasizing the need for targeted interventions and early detection.