Ace cards will kill the enemies in the correct order when possible. Familiars, especially ones that passively or actively damage enemies of their own accord, may make killing enemies in order difficult, if not impossible. This makes this item much less useful for Tainted Jacob. When playing as Tainted Jacob, Dark Esau can be marked by this item, and will be marked first if he is alive when you enter a room. If the doors open automatically due to spending a long enough time in the room, any existing mark will disappear. In the Mom boss fight, each of Mom's body parts (eyes, foot, and hands) is considered as a different enemy, and Isaac has to kill the foot to get the bonus. Enemies that are not spawned when the room is entered (such as Angels from bombed Angel Statues and enemies in Challenge Rooms, Greed Mode, and Boss Rush) will not be marked. If a Portal is marked and despawns, no other enemy will be marked and the bonus is lost. If a reward stat is chosen that is already at maximum, the sound effect and Isaac's thumbs up animation will play, but there is no other effect. A room with no enemies that instead requires Silver Buttons to be pressed will also give a reward when cleared. Bishops can shield the marked enemy unless frozen or petrified beforehand. If new enemies are spawned via Portals or on death, they are added to the end of the marked queue. The marked enemies are chosen in the same order in a given room, starting from the top-left corner with enemies that are vulnerable at their spawn time. 
As long as the room is not cleared, Isaac can re-attempt a Death's List by leaving and re-entering.If a non-marked enemy is killed, the skull will disappear and no bonuses will be granted for that room.
A Soul Heart, a pill, a Key, a Bomb, or a Nickel.If all enemies in the room are cleared in the order they are marked, Isaac gains one of the following rewards at random:.Killing the marked enemy will cause the skull to move to a different enemy.
Upon entering a room, a skull appears over an enemy's head.
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