[Significance of the clinical and dermatoscopic findings, histopathology and reflex confocal microscopy (RCM) in determining the origin of melanocytic lesions: an analysis based on a clinical case].

Dysplastic nevi (DN) are pigmented lesions combining the features of typical nevomelanocytic nevi, as well as some of the clinical and histological characteristics of malignant melanoma (MM). DN are associated with an increased risk of developing a MM. The genetic predisposition and intensive sun exposure are some of the main etiologic factors for their evolution. The clinical and the dermatoscopic findings may be misleading in the estimation of the diagnosis of malignant melanoma or a dysplastic nevus. Precisely because of this fact, the determination of the optimal treatment plan for each individual patient could be a challenge. The confocal microscopy is one of the new methods that is capable to contribute in a high percentage of the cases for this precise differentiation. Unfortunately, its application is not widespread, and the methodology is labor intensive and additional training and qualification are required. We present a case of a female patient with DN in which clinical and dermatoscopic findings were speaking rather in favor of malignant melanoma but after the subsequent surgical excision, the histopathological evaluation rejected this doubt, definitively. In cases of lesions with difficult location for surgical treatment and unclear clinical and dermatoscopic findings, reflex confocal microscopy (RCM) could be a possible elegant solution which prevents of stigmatization of the patients from different multiple and often unnecessary surgical approaches.