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• In vivo confocal microscopy allows non-invasive “optical biopsy” with the visualisation of the morphology and organisation of the cells in depth of the skin. It is useful for doubtful lesions on dermoscopy and to assess the margins of some lesions (i.e. amelanotic melanoma, lentigo maligna).

• Lentigo maligna (LM) is a slow growing form of melanoma in situ that can be difficult to recognise. LM can resemble a freckle and develops in heavily sun-damaged older skin, especially on the head and neck.

  • Confocal microscopy allows differentiating LM from benign freckles or solar lentigines, avoiding biopsies in cosmetically sensitive areas.

  • It is also useful when there is a suspicious lesion prior to cosmetic procedures to reassure facial pigmented macules are benign.

  • Margin determination of LM can be challenging because it’s frequent amelanotic component (non pigmented area with melanoma cells that extend beyond the pigmentation we see on the skin), therefore there is more frequent local recurrence than other types of melanoma.

  • Confocal microscopy can help delineate the margins before the surgery or to decide the better treatment approach depending on the extent of the lesion.​