Objective To obtain the dermoscopic features of atypical molluscum contagiosum by comparing the image characteristics of solitary atypical molluscum contagiosum with multiple typical molluscum contagiosum.Methods Twenty-eight cases of atypical solitary molluscum contagiosum (28 lesions) with incorrect initial diagnosis confirmed via pathological examination in our hospital from April 2016 to April 2019 were selected, and another twenty-eight cases of multiple typical molluscum contagiosum (168 lesions) during the same period were enrolled randomly. The dermoscopic characteristics were observed and compared between the two groups.Results There was no difference in the frequency of white round structure, four-leaf clover-like structure, or amorphous structure between the two groups (P > 0.05). The proportion of brown-yellow round structure was higher while that of orifice-like structure was lower in atypical solitary molluscum contagiosum (P < 0.05). Though not differing in the percentage of vessels in punctiform or linear patterns (P > 0.05), the percentage of vessels in crown patterns and the absence of vessels was lower but the percentage of vessels in mixed patterns was higher in atypical solitary molluscum contagiosum relative to multiple typical molluscum contagiosum (P < 0.05). Besides, the number of bright white round structure and brown-yellow round structure was greater in atypical solitary molluscum contagiosum (P < 0.05).Conclusions Compared with multiple molluscum contagiosum, the images of solitary atypical molluscum contagiosum show different characteristics in dermoscopy. Thus, the dermoscopic features can serve as a key point for differential diagnosis of solitary atypical molluscum contagiosum.