Similar but Different: How Reflectance Confocal Microscopy May Help in the Diagnosis of Pink Lesions

Background: Among skin neoplasms, solitary pink tumors represent challenging lesions in clinical practice since they can mimic melanocytic and nonmelanocytic lesions or even inflammatory ones. Objective: In this case series we described dermoscopic and confocal features of 2 couples of similar lesions in order to achieve the correct diagnosis and the best therapeutic approach. Methods: During clinical routine practice, 2 couples of clinically and dermoscopically similar lesions were examined by means of confocal microscopy. Results: All lesions revealed no clear-cut diagnostic features on dermoscopy. However, confocal microscopy revealed tumor islands with palisading cells and a dark clefting at the periphery in basal cell carcinomas. In the other "false twin" lesions, atypical cells and elongated junctional nests were observed and the diagnosis of amelanotic melanomas was rendered. Conclusions: In the current case series, the combined use of dermoscopy and reflectance confocal microscopy was an optimal workup for difficult-to-diagnose lesions such as pink tumors.