Because equine sarcoids are the most common skin tumors found in equids, we rarely seem to struggle with the diagnosis of equine sarcoid tumors. However, given this supposedly high index of diagnostic confidence, sarcoids may be overdiagnosed. How reliable is the clinical diagnosis for equine sarcoids? Are there any red flags that may indicate other differentials? What options are available to confirm or rule out a suspected diagnosis of equine sarcoids? Countless treatments with a fairly legitimate backgrounds are used to treat equine sarcoids. This implies that none of the available treatments is universally effective, available, affordable, or practical. Given the wide spectrum of disease manifestations and lacking comparisons of the therapeutic efficacy for the different options available, it can be challenging to choose the most appropriate treatment option. This presentation covers the rationale for the lecturer’s current treatment and disease management approaches, illustrating on a selection of challenging cases.