Clinical Applicability of in vivo Reflectance Confocal Microscopy for the Diagnosis of Actinic Keratoses

Abstract

In summary, RCM may be a promising technology for the noninvasive detection of AK and as adjunct tool to clinical diagnosis and monitoring. However, the preliminary nature of this study warrants further investigations.

Reflectance Confocal Microscopy for Noninvasive Monitoring of Therapy and Detection of Subclinical Actinic Keratoses

“…Another patient (patient 2) showed clearance on clinical examination but persistence of AK features (atypia of the stratum granulosum and spinosum) and inflammation on RCM examination. Overall, the stratum corneum showed a more homogeneous appearance and increased cohesiveness of corneocytes comparable to findings observed in normal, unaffected skin sites [25,26,27]. RCM images obtained at the level of the stratum granulosum and spinosum showed a more regular appearance of keratinocytes, with polygonal cells arranged in a typical honeycomb pattern (9/11).…”

“…In an attempt to increase diagnostic accuracy with noninvasive imaging technologies, a number of adjunct diagnostic devices have been evaluated for their clinical applicability. Among others, recent studies reported high sensitivity and specificity rates for diagnosis of AK by RCM in vivo [26,27]. …”

“…Neoplastic, inflammatory, regenerative and vascular changes were documented in both clinical and subclinical AK sites using RCM evaluation parameters for AK as published previously [26,27]. …”

“…Similarly, 4–6 individual RCM images were captured in each epidermal layer, following a standardized evaluation protocol and individually subjected to descriptive analysis during the evaluation process. Based on previously defined RCM criteria, specific study sites were evaluated for the presence or absence of RCM features of AK [25,26,27]. The presence of main features was indicative of AK: disruption of the stratum corneum, individual corneocytes, parakeratosis/hyperkeratosis, overall architectural disruption, nuclear atypia/cellular pleomorphism at the level of the basal, spinous and granular layer.…”

“…A single image allows in vivo evaluation of a 500 × 500 µm area and by scanning of the microscope composite images, up to 8 × 8 mm can be obtained. RCM has been used for the evaluation of a variety of inflammatory and neoplastic skin disorders [19,20,21,22,23,24]; recently, the clinically applicability of this method for the evaluation of AK has been investigated [25,26,27]. It was postulated that initial changes of epidermal morphology and cellular atypia may be visualized by RCM before becoming clinically apparent.…”