Purpose <p>To investigate the characteristic manifestations of basal cell carcinoma (BCC) under dermoscopy and reflectance confocal microscopy (RCM) and explore the diagnostic value of dermoscopy combined with RCM for BCC.</p> Methods <p>A cohort of 71 patients with the suspected clinical diagnosis of BCC underwent dermoscopy, RCM, and histopathological examinations. The concordance of dermoscopy, RCM, and dermoscopy combined with RCM with histopathology was individually assessed. Receiver operating characteristic (ROC) curves were constructed to compare the diagnostic performance of these modalities.</p> Results <p>Using histopathology as the reference standard, the sensitivity, specificity, and overall agreement rate were 95%, 81.82%, and 92.96% for dermoscopy; 96.67%, 72.73%, and 92.96% for RCM; and 98.30%, 81.80%, and 95.80% for dermoscopy + RCM, respectively. Assessment of the concordance of dermoscopy, RCM, and dermoscopy + RCM with histopathology yielded kappa values of 0.741, 0.721, and 0.832, respectively. The area under the ROC curve for dermoscopy, RCM, and dermoscopy + RCM were 0.884, 0.847, and 0.901, respectively, with dermoscopy + RCM demonstrating the best diagnostic efficacy.</p> Conclusion <p>This study elucidated the common characteristic features of BCC, as visualized on dermoscopy and RCM, indicating the enhanced diagnostic efficacy of combining dermoscopy with RCM in BCC.</p>