Congenital melanocytic nevi are benign neoplasms, which present early in life at various anatomic locations with a variety of clinical presentations. When evaluating large or giant nevi, it's important to use a multidisciplinary team and rule out comorbid conditions, such as neurocutaneous melanosis. Surgical interventions include direct excision, serial excision, and tissue expansion. For more complex lesions, tissue expansion is a versatile and effective option for many areas of the body. Most large or giant lesions require serial excision and long-term follow-up.