Rapid diagnosis of suspicious pigmented skin lesions is imperative; however, current bedside skin imaging technologies are either limited in penetration depth or resolution. Combining imaging methods is there-fore highly relevant for skin cancer diagnostics. This pilot study evaluated the ability of optical coherence tomography, reflectance confocal microscopy, photo-acoustic imaging and high-frequency ultrasound to differentiate malignant from benign pigmented skin lesions. A total of 41 pigmented skin tumours were scanned prior to excision. Morphological features and blood vessel characteristics were analysed with reflectance confocal microscopy, optical coherence tomography, high-frequency ultrasound and photoacoustic imaging images, and the diagnostic accuracy was assessed. Three novel photoacous-tic imaging features, 7 reflectance confocal microscopy features, and 2 optical coherence tomography features were detected that had a high correlation with malignancy; diagnostic accuracy > 71%. No significant features were found in high-frequency ultrasound. In conclusion, optical coherence tomo-graphy, reflectance confocal microscopy and pho-toacoustic imaging in combination enable image-guided bedside evaluation of suspicious pigmented skin tumours. Combining these advanced techniques may enable more efficient diagnosis of skin cancer.