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Longitudinal melanonychia in children is most often a harmless, benign condition caused by a melanocytic nevus or melanocyte activation, but it can sometimes be challenging to distinguish from melanoma. While malignant melanoma is rare in this age group, a doctor should monitor the lesion for changes like increasing width or darkness, pigment variegation, or periungual pigmentation. Biopsy is usually avoided due to the risk of permanent nail dystrophy, so close, long-term monitoring is advised. When changes occur during time , dermatosurgical approach is recommended in order to clarify the genesis of the last mentioned above.