Vascular and pigmentary lesions comprise most birthmarks. Lesions range from uncommon to very common, some being essentially normal variants. The natural history of these lesions varies from being transient phenomena of no significance to permanent cutaneous abnormalities that may be associated with significant systemic complications or diseases. This article describes the most commonly encountered, clinically significant lesions according to topography and clinical presentation, stressing diagnosis and findings that should prompt early assessment and treatment.