Proper differentiation between acral malignant melanoma and benign pigmented lesions like melanocytic nevi is of great value. To avoid unnecessary biopsies, dermatoscopy has been introduced as a non-invasive modality and has improved the clinical diagnostic accuracy in recent decades. We aimed to describe dermoscopic patterns of acral pigmented lesions of patients in the clinic of dermatology in Razi Hospital, Tehran, Iran. This study was conducted as a descriptional study among a total of 62 pigmented lesions located on volar skin of palms and soles. After initial clinical evaluation, lesions were examined entirely by dermoscopy. All the patterns within a lesion were described, and lesions suspicious of malignancy (clinically or dermatoscopically) were selected for histopathological evaluation. Of our 62 lesions, three lesions were not melanocytic. According to our final clinicopathological diagnosis, 47 lesions were benign melanocytic nevi and 12 lesions were malignant melanoma. Parallel furrow pattern was the most frequent among our benign lesions (51.1%) followed by lattice-like pattern (23.4%) and acral reticular pattern (21.3%). Diffuse multi-component pattern, parallel ridge pattern and abrupt edge were respectively most common patterns among malignant melanomas. Acral benign melanocytic nevi and malignant melanomas respectively have well distinctive characteristics in dermatoscopy among our patients.