In vivo reflectance confocal microscopy as a response monitoring tool for actinic keratoses undergoing cryotherapy and photodynamic therapy

Clara Curiel-Lewandrowski, Caitlyn N. Myrdal, Kathylynn Saboda, Chengcheng Hu, Edith Arzberger, Giovanni Pellacani, Franz Josef Legat, Martina Ulrich, Petra Hochfellner, Margaret C. Oliviero, Paola Pasquali, Melissa Gill, Rainer Hofmann-Wellenhof

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Article number5488
JournalCancers
Volume13
Issue number21
DOIs
StatePublished - Nov 1 2021

Keywords

  • Actinic keratosis
  • Cryotherapy
  • Photodynamic therapy
  • RCM
  • Reflectance confocal microscopy
  • Response monitoring

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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