This paper presents a profile of evidence of disease in a skeletal sample from Taumako Island, Southeast Solomon Islands, Melanesia, and aims to increase awareness of the prehistoric Pacific Island disease environment. It also addresses issues of lesion recording, quantification, and interpretation. Two methodologies for the determination of lesion prevalence were applied, one based on prevalence in observable individuals and one in skeletal elements. The aim of these methodologies was to provide objective data on skeletal lesions in this sample, with transparency in methods for application in comparative studies. The types of lesions observed were predominantly osteoblastic and affecting multiple bones, particularly in the lower limbs. The individual analysis yielded a prevalence of lesions affecting 56.4% of the postcranial sample from birth to old age. As expected, the skeletal element analysis yielded a lower prevalence, with 15.0% of skeletal elements affected. The skeletal element analysis also revealed a pattern of greater lower limb involvement, with a predilection for the tibia. The pattern of skeletal involvement was similar in both analyses, suggesting the validity of employing either method in paleopathological studies. A differential diagnosis of the lesions included osteomyelitis, treponemal disease, and leprosy. Metabolic disease was also considered for subadult lesions. Based on lesion type, skeletal distribution, and epidemiology of lesions in the sample, an etiology of yaws (Treponema pertenue) was suggested as responsible for nearly half the adult lesions, while multiple causes, including yaws, were suggested for the lesions in subadults. Am J Phys Anthropol, 2003. © 2003 Wiley-Liss, Inc.