Melanoma imitators could be lesions of different genres; vascular, infectious (granulomatous) and non-melanocytic tumors in addition to various skin artifacts. Their early recognition is essential for the subsequent and sometimes invasive diagnostic and therapeutic approach by the clinician. This paper focuses on several unique cases involving patients with clinical signs of advanced stage melanoma that actually had either benign lesions or circumstances where surgical excision could be avoided. We also analyze the means through which an early aggressive approach to these lesions could be avoided. The performance of confocal microscopy in dermatologic oncology units is one of the most modern trends in dermatology. Thanks to this method, the differentiation between melanocytic and non melanocytic lesions as well as between vascular lesions and lesions with granulomatous genesis, is substantially facilitated. The use of this methodology in the field of dermatologic oncology can be essential in improving the efficiency of medical services and reducing the number of unjustified surgical excisions.