Malignant freckle-like nevus is a precancerous lesion, also known as Hutchinson’s melanin freckle. The cause of the disease is not yet clear, but may be related to sun exposure and age. It occurs in exposed areas, especially on the face, and in a few cases on the back of the hands and other limbs, with asymmetric patches of yellowish-brown, dark-brown, or black color. The disease can develop into malignant freckle-like nevus melanoma. Doctors will mainly clarify the condition through visual examination, palpation, dermoscopy and pathological examination, etc. Complete surgical excision is the first choice for treating this disease, which can be combined with radiotherapy if necessary. If malignant freckle-like nevus is diagnosed, it should be taken seriously, and it is recommended to carry out standardized treatment as soon as possible in order to reduce the adverse effects of the disease.