Knowledge of the molecular underpinnings of many epidermal nevi and epidermal nevus syndrome has expanded rapidly in recent years. In this review and update on epidermal nevus syndrome, we will cover recent genetic discoveries involving epidermal nevi, including nevus sebaceus, keratinocytic epidermal nevus, nevus comedonicus, congenital hemidysplasia with ichthyosiform nevus and limb defects syndrome, phakomatosis pigmentokeratotica, Becker's nevus, porokeratotic adnexal ostial nevus, inflammatory linear verrucous epidermal nevi, and cutaneous-skeletal hypophosphatemia syndrome. We will discuss how newly defined mutations relate to the biology reflected in the cutaneous patterns seen in these mosaic disorders and how new molecular data has informed our understanding of these diseases and shaped management decisions. We will discuss the more well-delineated EN and ENS, including keratinocytic EN, nevus sebaceus, nevus comedonicus (NC), congenital hemidysplasia with ichthyosiform nevus and limb defects (CHILD) syndrome, phakomatosis pigmentokeratotica, Becker's nevus, porokeratotic adnexal ostial nevus (PAON), inflammatory linear verrucous EN (ILVEN), and the newly described cutaneous-skeletal hypophosphatemia syndrome (CSHS). We will examine advances in the genetics of these disorders and highlight promising work in the translation to management for our patients. We will also briefly discuss less well-defined EN and ENS associated with overgrowth syndromes.