Melanisation can occur in the musculature of fish. A well-known form is the melanised focal changes, or 'black spots', in the fillet of farmed Atlantic salmon (Salmo salar). The aetiology of black spots has not been fully determined, though recent research has emphasised the role of fat necrosis in their development. The initial stages of the changes are observed as focal haemorrhages or 'red spots', and these can progress into melanised focal changes (MFCs). The focal haemorrhages are acute changes characterised by necrotic myocytes and adipocytes and diffuse haemorrhage in the tissue. These changes evolve into a chronic inflammation dominated by fibrosis, encapsulated lipid droplets or pseudocysts, presence of epithelioid cells, granulomas of varying character, giant cells and melano-macrophages, whose presence accounts for the discolouration. The inflammation ranges from mild to severe, and the severity of the lesion has been associated with localised piscine orthoreovirus 1 (PRV 1) replication in macrophages and melano-macrophages within granulomas. The possibility of a genetic impact on the condition has not been supported by available data. The lipid composition and the antioxidative properties of the feed have been shown to affect the development of the changes. Physiological and environmental factors are also believed to influence the prevalence and severity of the condition. Here, we review the current state of knowledge concerning melanisation in fish skeletal musculature, with a special emphasis on the MFCs in Atlantic salmon.