title: "Twin lesions": Which one is the bad one? Improvement of clinical diagnosis with reflectance confocal microscopy.
abstract: BACKGROUND
  In vivo reflectance confocal microscopy (RCM) is a novel non-invasive diagnostic tool, which is used to differentiate skin lesions. Even in lesions with similar dermatoscopic images, RCM may improve diagnostic accuracy.
  
  
  METHODS
  Three sets of false "twin lesions" with similar macroscopic and dermatoscopic images are matched. All lesions are evaluated with RCM and lesions are excised for further evaluation. Corresponding features in confocal images, dermatoscopy and histopathology are discussed.
  
  
  RESULTS
  In all matched pairs, one of the lesions was diagnosed as melanoma with the observation of melanoma findings such as: epidermal disarray, pagetoid cells in epidermis and cellular atypia at the junction. Benign lesions were differentiated easily with RCM imaging.
  
  
  CONCLUSIONS
  Examining dermatoscopically difficult and/or similar lesions with RCM facilitates diagnostic and therapeutic decision making. Using RCM in daily practice may contribute to a decrease in unnecessary excisions.
authors.affiliation: Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany; Department of Dermatology and Venereology, Ankara University, Ankara, Turkey.
authors.forename: Secil
authors.initials: S
authors.lastname: Saral
authors.affiliation: Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany; Städtisches Klinikum München, Fachklinik für Dermatologie und Allergologie, Munich, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Hartmann
authors.affiliation: Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany; Städtisches Klinikum München, Fachklinik für Dermatologie und Allergologie, Munich, Germany.
authors.forename: Valerie
authors.initials: V
authors.lastname: Letulè
authors.affiliation: Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ruzicka
authors.affiliation: Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany; Städtisches Klinikum München, Fachklinik für Dermatologie und Allergologie, Munich, Germany.
authors.forename: Cristel
authors.initials: C
authors.lastname: Ruini
authors.affiliation: Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany; Städtisches Klinikum München, Fachklinik für Dermatologie und Allergologie, Munich, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: von Braunmühl
keywords: clinical diagnosis; dermatoscopy; melanoma; nevus; reflectance confocal microscopy; skin imaging