We study photoacoustic imaging (PAI) for diagnosing pigmented skin lesions. Clinical examination of nevi is challenging, leading to unnecessary skin biopsies. While dermoscopy improves accuracy, false positives remain high. PAI combines optical and ultrasound imaging by providing 3D images that visualize endogenous chromophores as melanin, haemoglobin, collagen and lipids at centimetre-depth. Reflectance confocal microscopy (RCM) offers in vivo cellular-level resolution improving diagnostic accuracy and demonstrating a 40% reduction in nevi excisions. By incorporating PAI alongside established methods, we aim to improve diagnostic precision.