• small cell melanoma
• Spitz's naevus
• diagnostic difficulty

The recent correspondence^1–2 following the paper on small cell melanoma³ indicates that experts cannot agree on this entity. It may well be the next Spitz's naevus, but will it be OK with Blessing et al if it is the equivalent of an activated junctional naevus, a metastasising Spitz's naevus, or one of the many other diagnostic (non) entities that clutter the field of melanocytic pathology. And if it does turn out to be benign, what of the overtreatment, morbidity, and life insurance problems that have been created? A diagnostic category avoided by most experts is “don't know”. If the lesion is absent from the margins it is probably completely and adequately excised and no further treatment has been proved to be beneficial. In such cases the referring clinician may seek a second opinion that will provide the “answer”, but a more pragmatic and honest approach is it is “definitely either benign or malignant”.