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A 51-year-old female was admitted with a history of breathlessness, pain in the left shoulder and difficulty swallowing. A malignant melanoma had been removed from her epigastrium in 1982; in 2002, another pigmented lesion was removed from her cheek. This lesion was benign (Lentigo simplex). On examination, the patient had distended neck veins on the left side and showed clinical signs of left pleural effusion. She also had a highly pigmented lesion over the malar area, present for about 12 months, which was not investigated. Initial investigations showed haemaglobin 11.4 g·dL-1 with mean corpuscular volume 86.2 fL and C reactive protein of 60 mg·dL-1 (normal range 0–10 mg·dL-1). Renal function, liver func-tion, calcium, phosphorus and serum elec-trophoresis were normal. Serum lactate dehydro-genase (LDH) was raised to 1,855 IU (normal range 0–400 IU). Chest radiography showed left-sided pleural effusion along with widened mediastinum. The patient went on to undergo a diagnostic pleural aspirate (figure 1). Can you identify this uncommon cause of pleural effusion