Primary malignant melanotic nerve sheath tumours, previously called Melanotic schwannomas are rare pigmented tumours of nerve sheath origin, with unspecified biologic behaviour and uncommon presentation in the head and neck region. A primary melanotic schwannoma of the cervical sympathetic plexus, mimicking a cervical lymphadenopathy requires careful evaluation and planning for an optimal outcome. The management of these neoplasms is still controversial, and hence we present a case report with insight into the diagnostic dilemma in work-up of a neck mass that turned out to be a Primary Malignant Melanotic Schwannoma arising from the cervical sympathetic plexus along with a review of literature. [ABSTRACT FROM AUTHOR]