Patients commonly seek the expertise of dermatologists to evaluate and treat pigmented lesions. Given the increasing incidence of melanoma and the potential for cure with early detection, such visits serve as an important opportunity to rule out malignancy and provide education about future risk. These interventions are especially important in otherwise healthy patients who may be seeking cosmetic treatment. Numerous treatment options are available for benign pigmented lesions; however, these should be approached with caution until their malignant counterparts have been excluded. Whether a patient presents for a routine skin check or treatment of a “dark spot” on the face, clinicians must utilize their diagnostic expertise before pursuing a treatment that may delay melanoma detection. This chapter will focus on the diagnosis and treatment of melanoma from a cosmetic perspective, structured around 2 common clinical scenarios. We will review the differential diagnosis and clinical tools we use to arrive at the correct diagnosis and then discuss cosmetic considerations in the treatment of melanoma.