The histopathologic pattern of EB nevus ranges from the readily recognizable congenital pattern to a problematic persistent/pseudomelanoma pattern.1- 5 Most persistent patterns occur in patients with recessive dystrophic EB, whereas the congenital pattern occurs more frequently in patients with EB simplex. Obviously, the fibrosing inflammation that is more frequently encountered in recessive dystrophic EB accounts for this observation. Some of the large lesions, even those with an ominous clinical appearance, display a banal compound congenital pattern, ie, monomorphous melanocytes in nests and fascicles spanning the papillary and reticular dermis with angiotropism and adnexotropism.1,3,8 Other patients, like ours, have shown the persistent pattern, ie, uneven distribution of melanocytes within the epidermis and dermal melanocytes enveloped in fibrosis. The persistent pattern raises the differential diagnosis of persistent melanoma vs persistent melanocytic nevus. Diagnosing persistent nevus becomes problematic if sections from the previous procedure are not available and/or if only the portion of the persistent melanocytic neoplasm is biopsied, which may lack the readily recognizable conventional benign melanocytic pattern. In cases of large EB nevi, in which the entire lesion often cannot be sampled, the problem of the persistent pattern may not be resolvable on the basis of histologic sections alone because there are no previous sections to review and the entire lesion may not be available for review. Our patient represented such a dilemma. The clues that the lesion on our patient was benign included melanocytes in the dermis that were monomorphous, a lack of mitosis, and, accordingly, a normal proliferative index. In addition, the lesion in our patient had a striking clinical resemblance to a large superficial spreading melanoma, but this clinical and histopathologic pattern of melanoma, although common in adults, is exceedingly rare in children. Melanomas in children are usually papular or nodular and thus have a prominent vertical orientation clinically and histopathologically rather than the horizontal orientation that is typical of the superficial spreading type of melanoma.9,10 The knowledge of the EB nevus phenomenon and the histopathologic features eventually convinced us of the benign nature of the lesion on our patient.