Application value of dermoscopy combined with reflectance confocal microscopy in field cancerization in actinic keratosis in the elderly
Objective To investigate the application value of dermoscopy and reflectance confocal microscopy(RCM)in identifying field cancerization in actinic keratosis(AK)in the elderly.Methods A retrospective analysis was conducted on clinical,dermoscopic,and RCM features of elderly(＞60 years old)patients,who were confirmedly diagnosed with AK and had complete medical records at Shanghai Skin Disease Hospital from January 2022 to December 2023.Results A total of 132 elderly patients with AK were included.Dermoscopy showed brownish-gray pseudonetwork pigment patterns,follicular horn plugs,irregular branched vessels,and rosette signs in AK lesions.Histopathological examination in 51 patients revealed that 47(92.16％)were confirmedly diagnosed with AK.Field cancerization was observed in 106 patients(80.3％),among whom 66(62.26％)had irregular branched vessels,88(83.02％)predominantly exhibited brownish-gray pseudonetwork pigment patterns,and 83(78.30％)showed scattered brown pigment networks/fingerprint-like patterns.Post-treatment follow-up of 63 patients showed varying degrees of changes in vascular and pigment structures by dermoscopy,with significant reductions in follicular horn plugs and superficial yellow-white scales or keratin masses.RCM examinations in 41 AK patients all showed disordered arrangements of keratinocytes presenting as atypical honeycomb patterns,with atypical cells in the AK lesions;in the field cancerization areas of 20 patients,RCM revealed keratinocytes disorderedly arranged in an irregular honeycomb pattern,with some keratinocytes exhibiting mild atypia.Thirty-four AK patients underwent dynamic RCM monitoring before and after 1,3 and 6 months of ALA-PDT treatment,which showed gradual regularization of arrangements of keratinocytes and reduction of atypical cells,as well as reappearance of atypical keratinocytes upon recurrence.Conclusions The incidence of field cancerization was relatively high in elderly AK patients.Dermoscopy and RCM are helpful for the early identification of AK and field cancerization,especially in patients with multiple lesions and with difficulties in multi-site biopsy.
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