The clinical diagnosis of cutaneous pigmented tumors is often difficult. Surface microscopy represents an interesting approach to this problem. For this in vivo investigation, a stereomicroscope, a glass slide and immersion oil are used. In order to improve the clinicopathological correlation of pigmented skin lesions, morphological criteria discerned by surface microscopy--such as pigment network or black dots--were compared with the corresponding histological features. Surface microscopy opens a new dimension for the diagnosis and differential diagnosis of malignant melanomas, dysplastic nevi, or non-melanocytic pigmented tumors, and allows a better pre-operative assessment of these lesions.