Choroidal neovascularization (CNV) is a pathological angiogenic process observed in various fundus diseases, including choroidal nevi. This article reviews key information on the pathogenesis of CNV associated with choroidal nevi, examines diagnostic methods using optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A), including modern classifications and criteria for assessing disease activity. The article also discusses approaches to the differential diagnosis of nevi combined with neovascular age-related macular degeneration, progressive nevi, and melanomas, and analyzes the features of treatment with antiangiogenic agents and their effects on pigmented choroidal lesions.