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Journal of the American Academy of Dermatology
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le vendredi 7 février 2020
Doi : 10.1016/j.jaad.2019.12.018
accepted : 11 December 2019
In vivo confocal microscopy of dermoscopic suspicious lesions in patients with xeroderma pigmentosum: A cross-sectional study

Lílian Rocha, MD , Paula Silva Ferreira, MD, João Avancini, MD, Silvia Lourenço, PhD, Caroline de Freitas Barbosa, MD, Caroline Colacique, MD, Cyro Festa-Neto, PhD
 Hospital das Clínicas of São Paulo University, São Paulo, Brazil 

Correspondence to: Lílian Rocha, MD, Av Dr Enéas de Carvalho, 255, São Paulo, Brazil.Av Dr Enéas de Carvalho, 255São PauloBrazil

Xeroderma pigmentosum (XP) is a rare genetic disease characterized by extreme photosensitivity, resulting in a higher incidence of cutaneous tumors. Reflectance confocal microscopy (RCM) is a noninvasive imaging method for diagnosing cutaneous lesions.


To explore the application of RCM in the follow-up of patients with XP.


Patients with XP underwent RCM for suspicious lesions from January 2010 through April 2019. Lesions with malignant RCM features were excised, and the results were compared with their histopathologic features. Benign lesions on RCM were monitored every 3 months. We recorded the confocal features that were related to malignancy and specifically to melanoma.


A total of 61 suspicious lesions from 13 patients with XP were included. Thirty-three lesions (54%) were malignant (14 melanomas, 15 basal cell carcinomas, and 4 squamous cell carcinomas).

Nonvisible papillae (OR, 11.8; 95% CI, 2.6-53.1; P  = .001) and atypical cells at the dermoepidermal junction (OR, 11.7; 95% CI, 2.7-50.3; P  = .001) were independent predictors of malignancy.


There were limited numbers of patients and lesions. Most cases were retrospectively included, and some did not have a histologic analysis.


RCM is a valuable tool in the follow-up of patients with XP, reducing the need for excisions by 35%.

The full text of this article is available in PDF format.

Key words : basal cell carcinoma, digital dermoscopy, melanoma, reflectance confocal microscopy, squamous cell carcinoma, total-body photography, xeroderma pigmentosum

Abbreviations used : BCC, CI, DEJ, OR, RCM, SCC, TBP, UV, XP

 Funding sources: None.
 Conflicts of interest: None disclosed.
 IRB approval status: Approved by the national and local ethics committees (Comitê de Ensino e Pesquisa [Research and Education Committee]-Certificado de Apresentação para Apreciação Étic [Presentation Certificate for Ethical Appreciation]: 98968918.0.0000.0068, parecer : 3.163.255).
 Reprints not available from the authors.

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