Kissing naevus arising from neural crest cells presenting as upper and the lower lid mass

A kissing nevus is a type of congenital compound nevus that affects equal portions of the upper and lower eyelid, and it extends to the lid margins. Congenital divided nevi of the eyelids are a rare melanocytic lesion. Only 30 patients are reported in the literature. We report a 40-year-old female of rural background who presented with a large painless enlarging pigmented mass, involving both upper and lower left eyelid since the past 20 years. Complete excision of the lesion was done, and the mass sent for histopathology, which revealed a compound nevus involving both lids. Surgery removed the obstruction, which had caused decreased visual acuity and had altered the cosmetic appearance of the patient. Lesions on the upper lid cause a mechanical ptosis, covers the visual axis, which causes obstruction in vision and is cosmetically unacceptable. There is a definite risk of malignant change in the nevus giving rise to malignant melanoma, and hence they should be removed as early as possible to give better functional and cosmetic results.