The blue nevus, also known as an acquired nevus, is a developmental lesion caused by aggregates of dendritic melanocytes that lie in the deep mucosa. The depth of the pigment creates a "Tyndall effect," which is what makes the melanin pigment appear blue. Although the literature reveals a 2:1 female predilection, this may be related to female patients seeking care more often and having more cosmetic concerns than male patients. It represents approximately one-fifth to one-fourth of all intraoral melanocytic nevi. Most nevi are noticed in the second to fourth decade of life and are usually asymptomatic.