This pigmented lesion of the lower leg is a congenital nevus, which has been present from birth and remained virtually unchanged. Congenital nevi can be found in approximately 1% of Caucasian persons. This lesion usually presents as a raised dark to medium brown lesion with a sharp border and smooth or papillomatous surface. It is histologically similar to an ordinary nevus acquired after birth, but the congenital nevus cells extend to the deep dermis. The overall size of the congenital nevus is much larger than an ordinary nevus. Acquired melanocytic nevi in children are often Spitz nevi or related nevi. Melanoma in children younger than 10 years of age is extremely rare. There is a slight increased risk for melanoma arising in a congenital nevus. [Courtesy of Dr. Helen Livingston, Florida State University]

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