Melanocytic nevi are moles with localized proliferations of pigment cells called melanocytes in the skin. Melanocytic nevi presented at birth are named congenital melanocytic nevi. All other nevi, named acquired melanocytic nevi, develop after birth. Melanocytic nevi in children and adolescents have morphologic features and behavior that differ from nevi in adults. Ultraviolet light is the primary environmental influence on the number and location of nevi that develop during childhood. Atypical melanocytic nevi are acquired lesions that are often mistaken for melanoma. Atypical nevi usually begin to appear around puberty. More than 50 of acquired nevi and the presence of clinically atypical nevi positively correlate with melanoma risk. Many children want nevi removed for cosmetic reasons, and in most cases, they should be discouraged. Pediatric melanoma is rare, and it can occur on the base of congenital melanocytic naevi, or it can arise de novo. Surgical excision is cornerstone of therapy, and adjunctive therapies include chemotherapy, radiation therapy, and immunotherapy. Other pigmented lesions that are also present in pediatric population are halo nevus, “Café au lait” macula, congenital dermal melonocytosis, and Spitz nevi.