Congenital naevi are pigmented lesions or moles, which are present at birth. They can vary significantly in size. They increase in size and thickness in proportion to the growth of the child. When the lesion is thick or large, it is frequently associated with growth of hair, thus called Congenital Hairy Naevus. The treatment is dependent on the size and location. When it is small, a simple excision and closure is done. When the lesion is large and near to vital organs like eyes and nose, serial excision or skin grafting may be the method of choice in order not to distort the normal anatomy of the eye or nose. There is 3-15% risk of malignant change in a lifetime for large congenital naevus particularly the ones on the midline of the trunk.