The application of reflectance confocal microscopy in the diagnosis of facial pigmented lesions — case series

Facial pigmented lesions encompass a heterogeneous group of melanocytic and non-melanocytic disorders, which may pose diagnostic challenges due to overlapping clinical features. The implementation of non-invasive imaging techniques, including dermoscopy and reflectance confocal microscopy (RCM), has significantly improved diagnostic accuracy, minimizing unnecessary biopsies and scarring. In the study, three cases of clinically equivocal pigmented facial lesions are described along with their dermoscopic and RCM presentations. The article highlights the usefulness of RCM in differentiating pigmented facial lesions and its therapeutic implications, which are particularly crucial for this cosmetically sensitive area. Moreover, dermoscopic and RCM features of lentigo maligna, seborrheic keratosis, and lichen planus-like keratosis — three disorders with overlapping clinical manifestations — have been summarized.