This case report and literature review focuses on a 10-year-old female patient with dystrophic bullous epidermolysis who developed a new pigmented mole in the submandibular area. Clinically, the mole appeared as an irregular, double-colored macule with suspicious borders. Dermoscopy revealed a multicomponent pattern with multiple colors, an ill-defined network, black blotches, streaks, multiple dots, a blue-whitish veil, and perifollicular granularity. Despite its appearance, dermoscopy was recommended every six months due to the possibility of bullous epidermolysis nevi, a recently described entity in patients with dystrophic forms of the disease. Bullous epidermolysis nevi are large, asymmetrical, and often irregularly pigmented melanocytic nevi that occur in areas of previous blistering. Although they can be clinically and dermoscopically atypical, malignant transformation has not been reported. The authors emphasize the importance of dermoscopy in differentiating these nevi from melanoma, especially in patients with fragile skin, to avoid overtreatment. The discussion highlights the pathogenic theories behind the development of EB nevi and their analogy to recurrent nevi, where dermoscopy and histopathology can be misleading. Regular follow-up and dermoscopic monitoring are recommended for these patients.This case report and literature review focuses on a 10-year-old female patient with dystrophic bullous epidermolysis who developed a new pigmented mole in the submandibular area. Clinically, the mole appeared as an irregular, double-colored macule with suspicious borders. Dermoscopy revealed a multicomponent pattern with multiple colors, an ill-defined network, black blotches, streaks, multiple dots, a blue-whitish veil, and perifollicular granularity. Despite its appearance, dermoscopy was recommended every six months due to the possibility of bullous epidermolysis nevi, a recently described entity in patients with dystrophic forms of the disease. Bullous epidermolysis nevi are large, asymmetrical, and often irregularly pigmented melanocytic nevi that occur in areas of previous blistering. Although they can be clinically and dermoscopically atypical, malignant transformation has not been reported. The authors emphasize the importance of dermoscopy in differentiating these nevi from melanoma, especially in patients with fragile skin, to avoid overtreatment. The discussion highlights the pathogenic theories behind the development of EB nevi and their analogy to recurrent nevi, where dermoscopy and histopathology can be misleading. Regular follow-up and dermoscopic monitoring are recommended for these patients.