An 86 year old woman was admitted to hospital with a right lower lobe pneumonia. Sputum grew Streptococcus pneumoniae, and the patient responded well to treatment with antibiotics. Three weeks after admission she was transferred to a rehabilitation hospital to improve her mobility. Although seen by several doctors none had commented on a pigmented lesion on the left side of her cheek (figure 1). On specific inquiry the patient reported having had the skin lesion for at least 20 years. She had noted that it had increased slowly in size but did not think that it was important and had never sought a medical opinion about it. Following a dermatology review the lesion was biopsied and subsequently surgically removed.