| Autor: |
Curiel-Lewandrowski C; Division of Dermatology, The University of Arizona College of Medicine, Tucson, AZ 85724, USA.; The University of Arizona Cancer Center, Tucson, AZ 85724, USA., Myrdal CN; Division of Dermatology, The University of Arizona College of Medicine, Tucson, AZ 85724, USA., Saboda K; The University of Arizona Cancer Center, Tucson, AZ 85724, USA., Hu C; Department of Epidemiology and Biostatistics, Mel and Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85721, USA., Arzberger E; Department of Dermatology, Medical University of Graz, 8036 Graz, Austria., Pellacani G; Dermatology, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, La Sapienza University of Rome, 00185 Rome, Italy., Legat FJ; Department of Dermatology, Medical University of Graz, 8036 Graz, Austria., Ulrich M; CMB Collegium Medicum Berlin GmbH/Dermatology Office, 10117 Berlin, Germany., Hochfellner P; Department of Dermatology, Medical University of Graz, 8036 Graz, Austria., Oliviero MC; Skin and Cancer Associates, Fort Lauderdale, FL 33324, USA., Pasquali P; Pius Hospital of Valls, 43850 Tarragona, Spain.; Faculty of Medicine and Health Sciences, University of Alcalá de Henares, 28801 Madrid, Spain., Gill M; Faculty of Medicine and Health Sciences, University of Alcalá de Henares, 28801 Madrid, Spain.; Department of Pathology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA., Hofmann-Wellenhof R; Department of Dermatology, Medical University of Graz, 8036 Graz, Austria. |
| Abstrakt: |
Reflectance confocal microscopy (RCM) presents a non-invasive method to image actinic keratosis (AK) at a cellular level. However, RCM criteria for AK response monitoring vary across studies and a universal, standardized approach is lacking. We aimed to identify reliable AK response criteria and to compare the clinical and RCM evaluation of responses across AK severity grades. Twenty patients were included and randomized to receive either cryotherapy ( n = 10) or PDT ( n = 10). Clinical assessment and RCM evaluation of 12 criteria were performed in AK lesions and photodamaged skin at baseline, 3 and 6 months. We identified the RCM criteria that reliably characterize AK at baseline and display significant reduction following treatment. Those with the highest baseline odds ratio (OR), good interobserver agreement, and most significant change over time were atypical honeycomb pattern (OR: 12.7, CI: 5.7-28.1), hyperkeratosis (OR: 13.6, CI: 5.3-34.9), stratum corneum disruption (OR: 7.8, CI: 3.5-17.3), and disarranged epidermal pattern (OR: 6.5, CI: 2.9-14.8). Clinical evaluation demonstrated a significant treatment response without relapse. However, in grade 2 AK, 10/12 RCM parameters increased from 3 to 6 months, which suggested early subclinical recurrence detection by RCM. Incorporating standardized RCM protocols for the assessment of AK may enable a more meaningful comparison across clinical trials, while allowing for the early detection of relapses and evaluation of biological responses to therapy over time. |
