Among the skin disorders reflecting mosaicism, two major morphological categories are nonsegmental and segmental mosaicism. On the other hand, two major genetic categories are genomic mosaics and epigenetic mosaics. In genomic mosaicism we can discriminate lethal from nonlethal mutations. Lethal mutations can only survive in a mosaic state. By contrast, nonlethal mutations, when transmitted to the next generation, cause a diffuse, nonmosaic involvement, or they give rise to disseminated mosaicism as noted, for example, in hereditary traits characterized by multiple benign skin tumors. A simple segmental manifestation reflects a postzygotic mutation occurring in an otherwise healthy embryo, whereas a superimposed mosaic manifestation is overlaid on a diffuse, nonsegmental involvement and reflects loss of the corresponding wild-type allele occurring in a heterozygous embryo. In common polygenic skin disorders such as psoriasis, a pronounced, superimposed segmental manifestation may originate from early loss of heterozygosity or from a postzygotic new mutation occurring at an additional predisposing gene locus. In autosomal recessive traits, heterozygous individuals are usually healthy. Rarely, however, the disorder becomes manifest in mosaic form when the corresponding wild-type allele is lost at an early developmental stage, giving rise to a homozygous or compound heterozygous patch. Twin spots are paired patches that differ genetically from each other and from the surrounding background tissue. In human skin, possible examples are cutis tricolor and paired nevus flammeus and nevus anemicus. In epidermolysis bullosa and other genodermatoses, revertant mosaicism may result from a postzygotic back mutation, giving rise to patches of healthy skin. Epigenetic mosaicism of autosomes has been studied in mice and dogs and may also occur in humans. Epigenetic mosaicism of X chromosomes results in a linear or otherwise segmental pattern in various X-linked skin disorders. In some of these traits such as incontinentia pigmenti or focal dermal hypoplasia, X inactivation accounts for survival of female embryos, whereas male embryos carrying the mutation usually die in utero. By way of exception, however, male embryos with a 46,XY karyotype may survive because they carry a postzygotic new mutation giving rise to genomic mosaicism, or because they have a 47,XXY karyotype resulting in functional X-chromosome mosaicism. It should be borne in mind that not all of the X-linked human genes are inactivated. For example, the gene of X-linked recessive ichthyosis escapes inactivation, which is why female gene carries display a completely normal phenotype.