Is there any update on this? Right now you have to download the image file, browse computer to open with Skitch, copy-paste into Evernote (and delete the old file if you just want the new annotated/edited image). The fewest steps I can get is: 1.) copy image from Evernote; 2.) open Skitch; 3.) paste into Skitch; 4.) edit/annotate image; 5.) copy image from Skitch; and 6.) paste image back into Evernote. Then if you want to do more than just that one image, you have to close Skitch, go to Evernote, right-click your next image, and select "Open With..." then "Skitch" from the context menu to be able to edit that second image, etc. Not horrible once you get the hang of it, but it could be more streamlined. Evernote has made it is an intuitive feature for other items such as word documents to be able to double-click (which opens the file), edit, then save +/ close which saves the file right back to the note, so adding this same capacity for Skitch would provide a more consistent and user-friendly experience.