Objective To explore the dermoscopic characteristics of melanocytic nevi on the acral volar area in children and adolescents, and to analyze the distribution of different dermoscopic patterns in different anatomic localization. Methods The clinical data and dermoscopic images of patients with acral volar melanocytic nevi in Dermatology Department from June 2022 to June 2025 were analyzed retrospectively. Results A total of 138 melanocytic nevi in 129 pediatric patients were included, among which 120 cases were single acral volar melanocytic nevi and the remaining 9 cases were multiple acral volar melanocytic nevi. Among them, there were 57 girls (44.2%) and 72 boys (55.8%), with a median age of 5.00 (2.75-7.00) years. Among the 34 patients, 39 melanocytic nevi were located on the palms, and in 95 patients, 99 melanocytic nevi were located on the soles. The most common dermoscopic pattern was the parallel furrow pattern (43/138, 31.2%), followed by the the peas-in-a-pod pattern (32/138, 23.2%) and the fibrillar pattern (28/138, 20.3%). There is a statistically significant difference in the distribution of different anatomic localisation among different dermoscopic patterns (χ²=50.78, P<0.001). The chi-square partition test was used for pairwise comparisons, and it was found that the lattice-like pattern in the plantar arch area had a higher proportion compared to the parallel furrow pattern, the fibrillar pattern, and the peas-in-a-pod pattern. In the weight-bearing area of the sole (including the metatarsal area, the heel area, and the lateral midfoot area), the proportion of the fibrillar pattern was higher than that of the lattice-like pattern. In the volar surface of the fingers, the proportion of the peas-in-a-pod pattern was higher than that of the fibrillar pattern. All differences were statistically significant (P<0.005). Conclusions The dermoscopic patterns of acral volar melanocytic nevi in children and adolescents may be related to the anatomic localization. The lattice-like pattern is more common in the plantar arch area, the fibrillar pattern is more likely to occur in the weight-bearing area of the sole, and the peas-in-a-pod pattern is often seen on the volar surface of the fingers.