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Background Acral lentiginous melanoma ( ALM) can be difficult to differentiate from acral nevus. Reflectance confocal microscopy ( RCM) is widely used for the diagnosis of melanocytic tumours, but the RCM features of ALM and acral nevus have not been described yet. Objective To determine the RCM features of ALM and acral nevus, and their correlation with clinical and histological characteristics. Methods Retrospective study of 17 cases of ALM and 26 acral nevi. Results Pagetoid cells were present in all ALMs with a visible epidermis and in three nevi. A proliferation of atypical melanocytes at the dermal-epidermal junction ( DEJ) and/or in the dermis was visible in nine ALMs but not in nevi. The histopathological examination of initial skin biopsies was unable to diagnose ALM in four cases, differing from RCM that could identify malignant tumour cells by exploring the whole lesions. Conclusion Reflectance confocal microscopy can help in the differentiation of ALM and acral nevus, and to guide the biopsy. [ABSTRACT FROM AUTHOR]

Background and objectives: The differential diagnosis between vulvar naevi and melanoma is challenging. In vivo reflectance-mode confocal microscopy (RCM) is an emerging technique that allows non-invasive high-resolution imaging of the skin and mucosa. It has recently been used for the study of vulvar melanosis and melanoma, but it has not been so far employed for the diagnosis of genital naevi. The objective of this study is to evaluate RCM features of vulvar naevi and to compare them with dermoscopical and histopathological aspects. Methods: Clinical, dermoscopical, in vivo RCM and histological features of six vulvar naevi were evaluated. Results: The clinical and/or dermoscopical aspects were suspicious in all six cases. RCM showed a blue naevus, an atypical genital naevus, a junctional naevus and three compound naevi that were later confirmed by histological examination. In one compound naevus, RCM showed focal cytological atypia and architectural irregularity without clear features of malignancy, confirmed by histological examination. Conclusions: Reflectance-mode confocal microscopy can play a role in non-invasive diagnosis of vulvar naevi, but further broader studies are required to validate our observations. [ABSTRACT FROM AUTHOR]