Hereditary melanoma accounts for approximately 10% of melanoma cases and results from germline mutations that confer an elevated lifetime risk of cancer. High-penetrance genes, including CDKN2A, CDK4, BAP1, POT1, ACD, TERF2IP, and TERT, are strongly associated with familial melanoma syndromes and often confer additional susceptibility to pancreatic, renal, or neural tumors. Medium- and low-penetrance variants, such as those in MC1R, MITF, and pigmentation pathway genes (ASIP, TYR, TYRP1, OCA2, SLC45A2), further modify melanoma risk, frequently through interactions with environmental factors such as ultraviolet radiation exposure. Emerging genes, including ATM and MBD4, expand the spectrum of inherited risk, particularly in uveal melanoma. Genotype–phenotype correlations reveal characteristic features such as early age of onset, multiple primary melanomas, atypical nevi, and association with mixed cancer syndromes. While genetic testing facilitates targeted surveillance and preventive strategies, many familial cases lack identifiable pathogenic variants, underscoring the likely contribution of polygenic risk. Advances in molecular characterization and risk modeling are essential to refine early detection and optimize management of individuals with hereditary melanoma.