Juvenile xanthogranuloma in adulthood is an infrequent non-Langerhans cell histiocytosis, which may simulate malignant tumors such as basal cell carcinoma (BCC) or amelanotic melanoma. Dermoscopy has been described as a useful tool in the preoperative diagnosis of xanthogranuloma. We report a xanthogranuloma on the suprapubic area of a 48-year-old female, which clinically and dermoscopically mimicked a BCC with a yellowish hue and arborizing vessels. Reflectance confocal microscopy exhibited large highly refractive atypical cells in the dermis, some of them with pleomorphic nuclei, corresponding to Touton cells in the histopathological study. To our knowledge this is the first description of the clinical, dermoscopic and confocal microscopy correlations of a xanthogranuloma.