When I confer with a child about their writing, misspellings typically don't stick out like a sore thumb. They pretty much go unnoticed, and it's the content that grabs my attention. I certainly don't ignore spelling though. My spelling program is individualized, and each child's words come from their writing. Thus, I do spend time looking specifically at spelling when I'm not conferring. Most assuredly, I can always find a menagerie of good but incorrect words in their writing. Instead of being aggravated by misspellings, they can be something to rejoice over. (Okay, so there are a few that can get under my skin at this time of the year: wus, uv, thay.) :)
Misspelled words can be proof of a shift in a child's learning. When my emergent writer, who's lucky to hear and write any sounds in words, writes "lic" for "like" I'm going to rejoice. That's some good spelling for that little person. When a writer starts to realize that there are long vowel patterns in words and writes "fete" for "feet" I'm going to rejoice. It's incorrect, but it's good. Of course, not every misspelling is a good thing. My advanced writers and readers had better not be spelling "lic" or "fete" but they too have some great misspellings in their writing. It comes down to knowing the writer, where they came from, where they're at, where they're going next, and then being able to recognize the good in their misspellings.
(Look here if you're interested in reading about how individualized spelling looks in my room.)