Reflectance–mode confocal microscopy (RCM) is a new in vivo skin imaging technique. We present our one–year experience in RCM examinations in skin tumors and the retrospective analysis of patients enrolled in the Dermatological Department of ‘N. Paulescu’ Institute using the Fotofinder Dermoscope IIŴ for the dermatoscopy analysis and VivaScope 1500Ŵ for in vivo RCM. We established the rank of RCM in the complex algorithm of skin cancer diagnose, showing that the presented experience can open new possibilities to implement this automated image analyzing system in the routine practice. Our analyzed cases clearly showed that confocal microscopy, therefore, optical biopsy, could guide the clinician towards an accurate diagnosis before surgical removal. Moreover, we emphasized that the development of this technique increases the potential of future teledermatologic applications.