Conclusions: “Dark scarred,” “puckered pigmented” and “mixed color” lesions are generally endometriosis.  Other characteristic, identifiable lesions included white scar, red polyps, clear vesicles, adhesions, yellow brown patches, deep nodules and peritoneal pockets.  However, these other appearances are also seen with other pathology.  Although biopsy may have little risk, it may have even less benefit when lesions are dark and scarred or puckered and pigmented.  Biopsy and histology appear more useful for diagnosis of other pathology including cancer.