Abstract: A medical marking device can produce visible temporary marks, including at least one of indentations or colorations, in a specified pattern on skin or tissue of a patient. The marking device can include a body, such as a cap, that can removably attach over an end of a surgical marker. The body can include marking features, such as blades, optionally positioned at a longitudinal end of the body. The marking features can be pressed against the skin or tissue of the patient to form the visible temporary marks. The marking features can optionally be inked, optionally by the surgical marker, before the marks are formed. The marking features can optionally be distributed between a first subset, positioned generally along a line, and a second subset, positioned asymmetrically with respect to the line. An optional inclinometer can attach to the body to allow alignment to a horizontal direction.