e. Discussion Non-caseating granulomatous reactions may present as a delayed response to a graphite foreign body. 4 The introduction of a graphite foreign body may result from a pencil-tip injury. The histological findings presented in this case are consistent with a reaction to graphite, although other components of pencil lead, namely aluminium silicate and wax, can induce a reactive inflammatory process. 5 Whilst few graphite foreign body granulomas have been reported in the literature, all written cases describe a presentation some years after the initial pencil-tip injury, with patients presenting as late as 58 years after the injury. 6 It is reasonable that the absence of a pencil-tip injury here may be explained by the patient’s inability to recall such an event that may have occurred several decades earlier. In keeping with other reports, this case suggests that the response to a graphite foreign body is a delayed granulomatous reaction. Clinicians should consider the possibility of a pencil-tip injury when presented with a localised, pigmented lesion that shows dark, granular pigment on histological staining. Histological examination of the tissue was able to detect granulomatous changes, however it remains unclear whether sophisticated tests should be employed to detect the presence of graphite in tissues given that cases of pencil core granulomas are so rare. 7 In this case, a misdiagnosis of a blue naevus-like localised argyria did not drastically alter the patient’s management. However, the case should prompt us to consider the potentially devastating complications that arise as a result of diagnostic uncertainty. The literature has described a clinical resemblance between pencil core granulomas and malignant melanoma. 1 A misdiagnosis of a malignant melanoma could expose an otherwise well patient to harmful chemotherapeutic agents. Simultaneously, a misdiagnosis of a pencil-tip granuloma in the presence of melanoma could delay life-saving treatment. Fu