Two hundred and two cases of spindle cell nevi were reviewed. Fifty-three of these cases occurred in adults. The lesions in children occurred primarily on the face and secondarily on the extremities; in adults, they occurred primarily on the extremities and secondarily on the face. They were diagnosed clinically in 33 of 149 childhood and adolescent cases and only in three of the 53 adult cases. They were most commonly mistaken clinically for nevus cell nevi, melanomas, and histiocytomas in adults. Histologically, they are usually compound spindle cell nevi. They may appear first in childhood and persist into adulthood or may develop de novo later in life.