We reviewed literature data in order to better define clinical features of Spitz nevi (SNi) in children. Lots of interest has been given in the past decade to these neoplasms that due the clinical course and sometime the rapid onset, may often cause worrisome consultations. Dermoscopy has played an important role in the improved diagnostic capability of clinicians, regarding all melanocytic neoplasms and also SNi. The description of specific and typical dermoscopic patterns is largely reviewed as well as the new laboratory diagnostic tools in the field of dermatopathology.