Clinical dermoscopy has provided new insights into the diagnosis and classification of melanocytic neoplasms. There are only limited data on its applications in dermatopathology. In our laboratory, we routinely photograph all skin biopsies with ex vivo dermoscopy (EVD). We retrospectively reviewed 517 cutaneous biopsies with corresponding EVD images to determine whether EVD provides useful ancillary information in the histopathologic diagnosis of melanocytic neoplasms. Four hundred eighty-three cases (93.4%) yielded usable images. The lesions could be categorized according to a published dermoscopic classification system of melanocytic proliferations. Reticular pigmentation correlated with dysplastic nevi, globular pigmentation with congenital nevi, homogenous blue pigmentation with blue nevi, starburst peripheral globular pigmentation with Spitz nevi, and atypical pigment patterns with melanoma. Eighteen of 25 cases (72%) with ambiguous histopathology were assigned a more definite diagnosis when reviewed contemporaneously with EVD images. The surgical margins in 40 cases (7.7%) were reclassified when EVD images were included in the review. We found EVD to be a useful technique and advocate its use for diagnosis and clinical-pathologic correlation.