Despite the increasing awareness of malignant melanoma over the last 40 years, clinical diagnostic accuracy remains disappointing. Malignant melanoma can masquerade clinically as benign lesions (false negatives), and benign pigmented lesions can clinically simulate malignant melanoma (false positives). Histologic examination of pigmented lesions is therefore important to ensure proper diagnosis and treatment. We review many of the published reports of benign lesions mimicking melanoma and melanoma masquerading as other entities as well as present additional cases of clinical misdiagnoses of melanoma.