Zeglinski-Spinney and Kirchhof discuss the case of a 69-year-old woman presented to a dermatology clinic with a congenital melanocytic nevus on her right lower back. The nevus had new-onset pruritus and hyperpigmentation. Dermoscopy revealed findings concerning for malignancy, and a biopsy confirmed superficial spreading melanoma with a Breslow depth of 0.91 mm. The patient underwent wide local excision of the nevus and biopsy of the sentinel lymph node, which showed no metastasis. The melanoma was classified as localized invasive melanoma stage T1a N0 M0. The patient will be monitored regularly for new skin lesions and other signs of metastasis. Melanoma in congenital melanocytic nevi is uncommon but delays in diagnosis and treatment can increase the risk of morbidity and death. Annual skin assessments and monitoring are recommended for patients with larger nevi or other risk factors.