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This case is among the first reported instances of pediatric uveal melanoma masquerading as vitreous hemorrhage on ophthalmologic examination as well as on computed tomography and magnetic resonance imaging, illustrating how reliance on imaging alone can delay diagnosis when fundus visualization is obscured. A 10-year-old girl presented with unilateral vision loss; initial imaging suggested serous retinal detachment with vitreous hemorrhage, but persistent clinical suspicion for melanoma versus retinoblastoma prompted referral to a tertiary ocular oncology service, where magnetic resonance imaging revealed a gadolinium-enhancing intraocular mass. Enucleation was performed, and pathology confirmed spindle cell uveal melanoma (pT4aNxM0). Genetic and molecular testing showed low baseline metastatic risk despite large tumor size. The key takeaway is that persistent clinical suspicion, even when contradicted by initial radiologic interpretation, is essential in atypical pediatric presentations of intraocular hemorrhage, and multidisciplinary reevaluation can be diagnostic.