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Kandolf L, Peris K, Malvehy J, Mosterd K, Heppt MV, Fargnoli MC, Berking C, Arenberger P, Bylaite-Bučinskiene M, Del Marmol V, Dirschka T, Dreno B, Forsea AM, Harwood CA, Hauschild A, Heerfordt IM, Kauffman R, Kelleners-Smeets N, Lallas A, Lebbe C, Leiter U, Longo C, Mijušković Ž, Pellacani G, Puig S, Saiag P, Šitum M, Stockfleth E, Salavastru C, Stratigos A, Zalaudek I, Garbe C. European consensus-based interdisciplinary guideline for diagnosis, treatment and prevention of actinic keratoses, epithelial UV-induced dysplasia and field cancerization on behalf of European Association of Dermato-Oncology, European Dermatology Forum, European Academy of Dermatology and Venereology and Union of Medical Specialists (Union Européenne des Médecins Spécialistes). J Eur Acad Dermatol Venereol 2024; 38:1024-1047. [PMID: 38451047 DOI: 10.1111/jdv.19897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/23/2024] [Indexed: 03/08/2024]
Abstract
A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology, the European Dermatology Forum, the European Academy of Dermatology and Venereology, and the European Union of Medical Specialists was formed to develop European recommendations on AK diagnosis and treatment, based on current literature and expert consensus. This guideline addresses the epidemiology, diagnostics, risk stratification and treatments in immunocompetent as well as immunosuppressed patients. Actinic keratoses (AK) are potential precursors of cutaneous squamous cell carcinoma (cSCC) and display typical histopathologic and immunohistochemical features of this malignancy in an early stage. They can develop into cSSC in situ and become invasive in a low percentage of cases. AK is the most frequent neoplasia in white populations, frequently occurring within a cancerous field induced by ultraviolet radiation. Since it cannot be predicted, which lesion will progress to cSCC and when treatment is usually recommended. The diagnosis of AK and field cancerization is made by clinical examination. Dermatoscopy, confocal microscopy, optical coherence tomography or line-field confocal-OCT can help in the differential diagnosis of AK and other skin neoplasms. A biopsy is indicated in clinically and/or dermatoscopically suspicious and/or treatment-refractory lesions. The choice of treatment depends on patients' and lesion characteristics. For single non-hyperkeratotic lesions, the treatment can be started upon patient's request with destructive treatments or topical treatments. For multiple lesions, field cancerization treatment is advised with topical treatments and photodynamic therapy. Preventive measures such as sun protection, self-examination and repeated field cancerization treatments of previously affected skin areas in high-risk patients are advised.
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Affiliation(s)
- Lidija Kandolf
- Department of Dermatology, Faculty of Medicine, University of Defence, Military Medical Academy, Belgrade, Serbia
| | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endrocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, IDIBAPS, CIBER de Enfermedades Raras, Instituto Carlos III, University of Barcelona, Barcelona, Spain
| | - Klara Mosterd
- Department of Dermatology, Maastricht University Medical Centre+ Comprehensive Cancer Centre, Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CC ER-EMN), Erlangen, Germany
| | - Maria Concetta Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CC ER-EMN), Erlangen, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and University Hospital of Kralovske Vinohrady, Prague, Czech Republic
| | - Matilda Bylaite-Bučinskiene
- Clinic of Infectious Diseases and Dermatovenereology, Centre of Dermatovenereology, Vilnius University, Vilnius, Lithuania
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Dirschka
- Faculty of Health, University Witten-Herdecke, Witten, Germany
- CentroDerm Clinic, Wuppertal, Germany
| | - Brigitte Dreno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Ana-Maria Forsea
- Department of Oncologic Dermatology, Elias University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | - Ida Marie Heerfordt
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Roland Kauffman
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Centre+ Comprehensive Cancer Centre, Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Celeste Lebbe
- Université Paris Cite, AP-HP Dermato-oncology, Cancer institute APHP, Nord Paris cité, INSERM U976, Saint Louis Hospital, Paris, France
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Caterina Longo
- Skin Cancer Center, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Željko Mijušković
- Department of Dermatology, Faculty of Medicine, University of Defence, Military Medical Academy, Belgrade, Serbia
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Susana Puig
- Dermatology Department of Hospital Clinic of Barcelona, IDIBAPS, CIBER de Enfermedades Raras, Instituto Carlos III, University of Barcelona, Barcelona, Spain
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise Paré Hospital, APHP, & EA 4340 "Biomarkers in Cancerology and Hemato-Oncology", UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Mirna Šitum
- Department of Dermatology and Venereology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Eggert Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Carmen Salavastru
- Department of Pediatric Dermatology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alexander Stratigos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
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Soare C, Cozma EC, Celarel AM, Rosca AM, Lupu M, Voiculescu VM. Digitally Enhanced Methods for the Diagnosis and Monitoring of Treatment Responses in Actinic Keratoses: A New Avenue in Personalized Skin Care. Cancers (Basel) 2024; 16:484. [PMID: 38339236 PMCID: PMC10854727 DOI: 10.3390/cancers16030484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
Non-melanocytic skin cancers represent an important public health problem due to the increasing incidence and the important local destructive potential. Thus, the early diagnosis and treatment of precancerous lesions (actinic keratoses) is a priority for the dermatologist. In recent years, non-invasive skin imaging methods have seen an important development, moving from simple observational methods used in clinical research, to true diagnostic and treatment methods that make the dermatologist's life easier. Given the frequency of these precancerous lesions, their location on photo-exposed areas, as well as the long treatment periods, with variable, imprecise end-points, the need to use non-invasive imaging devices is increasingly evident to complete the clinical observations in the diagnosis and treatment of these lesions, with the aim of increasing accuracy and decreasing the adverse effects due to long treatment duration. This is the first review that brings together all skin imaging methods (dermoscopy, reflectance confocal microscopy, ultrasonography, dermoscopy-guided high frequency ultrasonography, and optical coherence tomography) used in the evaluation of actinic keratoses and their response to different treatment regimens.
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Affiliation(s)
- Cristina Soare
- Department of Oncological Dermatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (M.L.); (V.M.V.)
| | - Elena Codruta Cozma
- Department of Pathophysiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Dermatology and Allergology, Elias University Emergency Hospital, 011461 Bucharest, Romania;
| | - Ana Maria Celarel
- Department of Dermatology and Allergology, Elias University Emergency Hospital, 011461 Bucharest, Romania;
| | - Ana Maria Rosca
- Department of Dermatology, University Military Hospital “Dr. Carol Davila”, 010825 Bucharest, Romania;
| | - Mihai Lupu
- Department of Oncological Dermatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (M.L.); (V.M.V.)
| | - Vlad Mihai Voiculescu
- Department of Oncological Dermatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (M.L.); (V.M.V.)
- Department of Dermatology and Allergology, Elias University Emergency Hospital, 011461 Bucharest, Romania;
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Orte Cano C, Suppa M, del Marmol V. Where Artificial Intelligence Can Take Us in the Management and Understanding of Cancerization Fields. Cancers (Basel) 2023; 15:5264. [PMID: 37958437 PMCID: PMC10649750 DOI: 10.3390/cancers15215264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 11/15/2023] Open
Abstract
Squamous cell carcinoma and its precursor lesion actinic keratosis are often found together in areas of skin chronically exposed to sun, otherwise called cancerisation fields. The clinical assessment of cancerisation fields and the correct diagnosis of lesions within these fields is usually challenging for dermatologists. The recent adoption of skin cancer diagnostic imaging techniques, particularly LC-OCT, helps clinicians in guiding treatment decisions of cancerization fields in a non-invasive way. The combination of artificial intelligence and non-invasive skin imaging opens up many possibilities as AI can perform tasks impossible for humans in a reasonable amount of time. In this text we review past examples of the application of AI to dermatological images for actinic keratosis/squamous cell carcinoma diagnosis, and we discuss about the prospects of the application of AI for the characterization and management of cancerization fields.
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Affiliation(s)
- Carmen Orte Cano
- Department of Dermatology, Hôpital Erasme, HUB, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium
- Department of Dermato-Oncology, Institut Jules Bordet, HUB, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Mariano Suppa
- Department of Dermatology, Hôpital Erasme, HUB, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium
- Department of Dermato-Oncology, Institut Jules Bordet, HUB, Université Libre de Bruxelles, 1070 Brussels, Belgium
- Groupe d’Imagerie Cutanée Non Invasive (GICNI), Société Française de Dermatologie (SFD), 75008 Paris, France
| | - Véronique del Marmol
- Department of Dermatology, Hôpital Erasme, HUB, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium
- Department of Dermato-Oncology, Institut Jules Bordet, HUB, Université Libre de Bruxelles, 1070 Brussels, Belgium
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Mazur E, Reich A. Photodynamic Therapy is an Effective Treatment of Facial Pigmented Actinic Keratosis. Dermatol Ther (Heidelb) 2023:10.1007/s13555-023-00924-0. [PMID: 37162710 DOI: 10.1007/s13555-023-00924-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Actinic keratosis (AK), or solar keratosis, is a precancerous condition of the skin, mainly caused by excessive and chronic exposure to ultraviolet radiation. Pigmented AK (pAK) is a rare variant of AK. Photodynamic therapy (PDT) is widely used to treat the classical variant of AK, but very limited data are available on the use of PDT in patients with pAK. The objective of this study was to assess the usefulness of PDT in the treatment of pAK. METHODS The study included 16 patients with 20 pAK lesions treated with PDT. All skin lesions were clinically and dermatoscopically assessed for typical features characteristic of pAK. Reflectance confocal microscopy (RCM) was also used to assess keratinocyte atypia, confirm pAK diagnosis, and rule out other disease entities. RESULTS After three PDT sessions, the complete resolution of all clinical features of pAK was observed in 80% of the studied lesions. Dermatoscopically, 65% of the lesions achieved 100% response and no cellular atypia was seen in the follow-up RCM images of 85% of lesions. CONCLUSIONS Photodynamic therapy is an effective treatment modality for pAK in fair-skinned individuals.
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Affiliation(s)
- Ewelina Mazur
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
- Doctoral School of the University of Rzeszow, University of Rzeszow, Rzeszow, Poland
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland.
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FGFR2c Upregulation Contributes to Cancer-Associated Fibroblast Program Activation and to Enhanced Autophagy in Actinic Keratosis-Derived Dermal Fibroblasts: A Possible Role in Precancerous Cell/Stromal Cell Crosstalk. BIOLOGY 2023; 12:biology12030463. [PMID: 36979155 PMCID: PMC10045898 DOI: 10.3390/biology12030463] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023]
Abstract
Actinic keratosis (AK) is a preneoplastic skin disorder which can rapidly progress to cutaneous squamous cell carcinomas (SCCs). In light of our previous findings, indicating a possible oncogenic role of the mesenchymal isoform of FGFR2 (FGFR2c) aberrantly expressed in AK keratinocytes, we analyzed the possible tumor-promoting role of this receptor in the stromal AK counterpart in this work. Molecular analysis showed that, particularly in early AK lesions, FGFR2c dermal upregulation is accompanied by the downregulation of the cancer-associated fibroblasts (CAF) transcription repressor CSL, the upregulation of the CAF activator ULK3, and the consequent CAF gene induction. Immunofluorescence and molecular analysis, coupled with silencing approaches by siRNA, applied on primary cultures of KIN I-derived fibroblasts, indicated that FGFR2c upregulation contribute to CAF signature and the increased autophagy in response to FGF2. Magnetic bead-based multiplex assay, combined with FGFR2 signaling shut-off approaches, indicated that, especially in response to FGF2, IL-6 secretion could depend on FGFR2c high expression and signaling, suggesting the possible establishment of FGFR2c-dependent secretory autophagy, contributing to tumor-promoting factor release. Overall, our results identified FGFR2c as a signaling molecule involved in controlling precancerous/stromal cell oncogenic crosstalk, pointing to this receptor as a possible early molecular marker predictive for AK’s rapid malignant progression.
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Pellacani G, Argenziano G. New insights from non-invasive imaging: from prospection of skin photodamages to training with mobile application. J Eur Acad Dermatol Venereol 2022; 36 Suppl 6:38-50. [PMID: 35738810 PMCID: PMC9328152 DOI: 10.1111/jdv.18197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/15/2022] [Indexed: 11/28/2022]
Abstract
The incidence of non‐melanoma skin cancer is on the rise and melanoma is among the most common cancers in the United States. Establishing an early diagnosis is essential for improving the prognosis of patients with skin cancer. High‐resolution non‐invasive imaging techniques may represent key tools for helping to identify and monitor early signs of skin cancer in seemingly healthy skin. Cumulative lifetime sun exposure leads to photoaging and photocarcinogenenis and the reaction of the skin to this solar‐induced damage is balanced between the DNA repair and photoprotection defence mechanisms of melanocytes and keratinocytes. In the first part of this article we provide an overview of these defence mechanisms and of the photoaging process, and discuss how non‐invasive imaging can be used to evaluate these changes. We then propose a model in which skin aging manifestations can be classified according to subject‐specific sun‐damage reaction profiles observed by reflectance confocal microscopy (RCM) and optical coherence tomography (OCT). These photoaging profiles include an atrophic phenotype characterized by actinic keratosis, and a hypertrophic phenotype characterized by hyperplastic pigmented skin. According to our model, these phenotypes may be predictive of predispositions to different types of skin cancer: squamous cell carcinoma for the atrophic phenotype and lentigo maligna and freckles for the hypertrophic phenotype. In addition to RCM and OCT, dermoscopy is another non‐invasive technique that has improved the diagnosis of skin cancer. In the second part of this article, we describe how the YouDermoscopy™ application can improve skills and thus enhance the dermoscopic recognition of sun‐induced skin tumours, and then show how this training tool enables its users to collaborate with dermatologists worldwide to obtain second opinions for the diagnosis of ambiguous lesions. Altogether, RCM, OCT and dermoscopy are valuable tools that can contribute significantly to improving the early diagnosis of precancerous and cancerous lesions.
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Affiliation(s)
- G Pellacani
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, La Sapienza University of Rome, Rome, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania, Naples, Italy
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Fischman S, Pérez-Anker J, Tognetti L, Di Naro A, Suppa M, Cinotti E, Viel T, Monnier J, Rubegni P, Del Marmol V, Malvehy J, Puig S, Dubois A, Perrot JL. Non-invasive scoring of cellular atypia in keratinocyte cancers in 3D LC-OCT images using Deep Learning. Sci Rep 2022; 12:481. [PMID: 35013485 PMCID: PMC8748986 DOI: 10.1038/s41598-021-04395-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/22/2021] [Indexed: 01/20/2023] Open
Abstract
Diagnosis based on histopathology for skin cancer detection is today's gold standard and relies on the presence or absence of biomarkers and cellular atypia. However it suffers drawbacks: it requires a strong expertise and is time-consuming. Moreover the notion of atypia or dysplasia of the visible cells used for diagnosis is very subjective, with poor inter-rater agreement reported in the literature. Lastly, histology requires a biopsy which is an invasive procedure and only captures a small sample of the lesion, which is insufficient in the context of large fields of cancerization. Here we demonstrate that the notion of cellular atypia can be objectively defined and quantified with a non-invasive in-vivo approach in three dimensions (3D). A Deep Learning (DL) algorithm is trained to segment keratinocyte (KC) nuclei from Line-field Confocal Optical Coherence Tomography (LC-OCT) 3D images. Based on these segmentations, a series of quantitative, reproducible and biologically relevant metrics is derived to describe KC nuclei individually. We show that, using those metrics, simple and more complex definitions of atypia can be derived to discriminate between healthy and pathological skins, achieving Area Under the ROC Curve (AUC) scores superior than 0.965, largely outperforming medical experts on the same task with an AUC of 0.766. All together, our approach and findings open the door to a precise quantitative monitoring of skin lesions and treatments, offering a promising non-invasive tool for clinical studies to demonstrate the effects of a treatment and for clinicians to assess the severity of a lesion and follow the evolution of pre-cancerous lesions over time.
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Affiliation(s)
| | - Javiera Pérez-Anker
- Melanoma Unit, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
- CIBER de enfermedades raras, Instituto de Salud Carlos III, Barcelona, Spain
| | - Linda Tognetti
- Dermatology Unit - Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Angelo Di Naro
- Dermatology Unit - Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Mariano Suppa
- Department of Dermatology, Université Libre de Bruxelles, Hôpital Erasme, Brussels, Belgium
- Groupe d'Imagerie Cutanée Non Invasive (GICNI) of the Société Française de Dermatologie (SFD), Paris, France
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Elisa Cinotti
- Dermatology Unit - Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
- Groupe d'Imagerie Cutanée Non Invasive (GICNI) of the Société Française de Dermatologie (SFD), Paris, France
| | | | - Jilliana Monnier
- Groupe d'Imagerie Cutanée Non Invasive (GICNI) of the Société Française de Dermatologie (SFD), Paris, France
- Department of Dermatology and skin cancer, la Timone hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Pietro Rubegni
- Dermatology Unit - Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Véronique Del Marmol
- Department of Dermatology, Université Libre de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - Josep Malvehy
- Melanoma Unit, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
- CIBER de enfermedades raras, Instituto de Salud Carlos III, Barcelona, Spain
| | - Susana Puig
- Melanoma Unit, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
- CIBER de enfermedades raras, Instituto de Salud Carlos III, Barcelona, Spain
| | - Arnaud Dubois
- Université Paris-Saclay, Institut d'Optique Graduate School, Laboratoire Charles Fabry, Palaiseau, France
| | - Jean-Luc Perrot
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
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Curiel-Lewandrowski C, Myrdal CN, Saboda K, Hu C, Arzberger E, Pellacani G, Legat FJ, Ulrich M, Hochfellner P, Oliviero MC, Pasquali P, Gill M, Hofmann-Wellenhof R. In Vivo Reflectance Confocal Microscopy as a Response Monitoring Tool for Actinic Keratoses Undergoing Cryotherapy and Photodynamic Therapy. Cancers (Basel) 2021; 13:cancers13215488. [PMID: 34771651 PMCID: PMC8583298 DOI: 10.3390/cancers13215488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The assessment of actinic keratoses (AKs) in prevention and therapeutic trials, as well as clinical practice, could significantly benefit from the incorporation of non-invasive imaging technology. Such technology has the potential to enhance the objective evaluation of clinical and subclinical AKs with the added advantage of sequential monitoring. In vivo reflectance confocal microscopy (RCM) allows for the non-invasive imaging of AKs at a cellular level. We aimed to establish an in in vivo RCM protocol for AK response monitoring, ultimately leading to more reliable characterization of longitudinal responses and therapy optimization. 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.
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Affiliation(s)
- Clara Curiel-Lewandrowski
- Division of Dermatology, The University of Arizona College of Medicine, Tucson, AZ 85724, USA;
- The University of Arizona Cancer Center, Tucson, AZ 85724, USA;
- Correspondence:
| | - Caitlyn N. Myrdal
- Division of Dermatology, The University of Arizona College of Medicine, Tucson, AZ 85724, USA;
| | | | - Chengcheng Hu
- Department of Epidemiology and Biostatistics, Mel and Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85721, USA;
| | - Edith Arzberger
- Department of Dermatology, Medical University of Graz, 8036 Graz, Austria; (E.A.); (F.J.L.); (P.H.); (R.H.-W.)
| | - Giovanni Pellacani
- Dermatology, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, La Sapienza University of Rome, 00185 Rome, Italy;
| | - Franz Josef Legat
- Department of Dermatology, Medical University of Graz, 8036 Graz, Austria; (E.A.); (F.J.L.); (P.H.); (R.H.-W.)
| | - Martina Ulrich
- CMB Collegium Medicum Berlin GmbH/Dermatology Office, 10117 Berlin, Germany;
| | - Petra Hochfellner
- Department of Dermatology, Medical University of Graz, 8036 Graz, Austria; (E.A.); (F.J.L.); (P.H.); (R.H.-W.)
| | | | - Paola Pasquali
- Pius Hospital of Valls, 43850 Tarragona, Spain;
- Faculty of Medicine and Health Sciences, University of Alcalá de Henares, 28801 Madrid, Spain;
| | - Melissa Gill
- 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
| | - Rainer Hofmann-Wellenhof
- Department of Dermatology, Medical University of Graz, 8036 Graz, Austria; (E.A.); (F.J.L.); (P.H.); (R.H.-W.)
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9
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Guida S, Longhitano S, Ardigò M, Pampena R, Ciardo S, Bigi L, Mandel VD, Vaschieri C, Manfredini M, Pezzini C, Arginelli F, Farnetani F, Zerbinati N, Longo C, Pellacani G. Dermoscopy, confocal microscopy and optical coherence tomography features of main inflammatory and autoimmune skin diseases: A systematic review. Australas J Dermatol 2021; 63:15-26. [PMID: 34423852 DOI: 10.1111/ajd.13695] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/26/2021] [Accepted: 08/07/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND/OBJECTIVES Non-invasive skin imaging features of main skin inflammatory and autoimmune diseases have been reported, although a comprehensive review of their correlation with histopathologic features is currently lacking. Therefore, the aim of this paper was to review the correlation of dermoscopic, reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) criteria of main inflammatory and autoimmune skin diseases with their corresponding histopathologic criteria correlation. METHODS Studies on human subjects affected by main inflammatory and autoimmune diseases, defining the correlation of dermoscopic, RCM or OCT with histopathologic criteria, were included in the review. Five groups of diseases were identified and described: psoriasiform, spongiotic and interface dermatitis, bullous diseases and scleroderma. RESULTS Psoriasiform dermatitis was typified by white scales, corresponding to hyperkeratosis, and vessels, observed with RCM and OCT. Spongiosis, corresponding to dark areas within the epidermis with RCM and OCT, was the main feature of spongiotic dermatitis. Interface dermatitis was characterised by dermoepidermal junction obscuration. Blisters, typical of bullous diseases, were visualised as dark areas with RCM and OCT while scleroderma lesions were characterised by dermoscopic fibrotic beams, related to dermal thickness variations, with specific OCT and histopathologic correlations. CONCLUSIONS Although the role of RCM and OCT has yet to be defined in clinical practice, non-invasive skin imaging shows promising results on inflammatory and autoimmune skin diseases, due to the correlation with histopathologic features.
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Affiliation(s)
- Stefania Guida
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Sabrina Longhitano
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Ardigò
- Porphyria and Rare Diseases Unit, San Gallicano Dermatological Institute - IRCCS, Rome, Italy
| | - Riccardo Pampena
- Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Silvana Ciardo
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Bigi
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Victor Desmond Mandel
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Porphyria and Rare Diseases Unit, San Gallicano Dermatological Institute - IRCCS, Rome, Italy
| | - Cristina Vaschieri
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Manfredini
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudia Pezzini
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Federica Arginelli
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Farnetani
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Zerbinati
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Caterina Longo
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Giovanni Pellacani
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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10
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Ruini C, Schuh S, Gust C, Hartmann D, French LE, Sattler EC, Welzel J. In-Vivo LC-OCT Evaluation of the Downward Proliferation Pattern of Keratinocytes in Actinic Keratosis in Comparison with Histology: First Impressions from a Pilot Study. Cancers (Basel) 2021; 13:2856. [PMID: 34201052 PMCID: PMC8228287 DOI: 10.3390/cancers13122856] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/21/2022] Open
Abstract
It is known that actinic keratoses (AKs) can progress to invasive squamous cell carcinoma (SCC). The histological PRO grading of AKs is based on the growth pattern of basal keratinocytes and relates to their progression risk. AKs can be non-invasively characterized by line-field confocal optical coherence tomography (LC-OCT). The aim of the study was to define criteria for an LC-OCT grading of AKs based on the PRO classification and to correlate it with its histological counterpart. To evaluate the interobserver agreement for the LC-OCT PRO classification, fifty AKs were imaged by LC-OCT and biopsied for histopathology. PRO histological grading was assessed by an expert consensus, while two evaluator groups separately performed LC-OCT grading on vertical sections. The agreement between LC-OCT and histological PRO grading was 75% for all lesions (weighted kappa 0.66, 95% CI 0.48-0.83, p ≤ 0.001) and 85.4% when comparing the subgroups PRO I vs. PRO II/III (weighted kappa 0.64, 95% CI 0.40-0.88, p ≤ 0.001). The interobserver agreement for LC-OCT was 90% (Cohen's kappa 0.84, 95% CI 0.71-0.91, p ≤ 0.001). In this pilot study, we demonstrated that LC-OCT is potentially able to classify AKs based on the basal growth pattern of keratinocytes, in-vivo reproducing the PRO classification, with strong interobserver agreement and a good correlation with histopathology.
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Affiliation(s)
- Cristel Ruini
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
- PhD School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Sandra Schuh
- Department of Dermatology and Allergy, University Hospital, 86156 Augsburg, Germany;
| | - Charlotte Gust
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
| | - Lars Einar French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL 33125, USA
| | - Elke Christina Sattler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
| | - Julia Welzel
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
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11
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Ciardo S, Pezzini C, Guida S, Del Duca E, Ungar J, Guttman-Yassky E, Manfredini M, Farnetani F, Longo C, Pellacani G. A plea for standardization of confocal microscopy and optical coherence tomography parameters to evaluate physiological and para-physiological skin conditions in cosmetic science. Exp Dermatol 2021; 30:911-922. [PMID: 33884663 DOI: 10.1111/exd.14359] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/17/2021] [Accepted: 04/07/2021] [Indexed: 12/11/2022]
Abstract
Non-invasive reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) have been extended to the dermo-cosmetic field, for skin pathophysiology understanding and therapeutics monitoring. However, standardized methodology and parameters to interpret structures and changes in these settings are still lacking. Present study aimed to propose a validated standard methodology and a list of defined parameters for objective non-pathological skin assessments in the cosmetically sensitive cheekbone area of the face. OCT and RCM quantitative, semi-quantitative and qualitative features were considered for assessments. Validation process included 50 sets of images divided into two age groups. Inter-rater reliability was explored to assess the influence of the proposed methodology. Quantitative OCT parameters of "epidermal thickness," "density and attenuation coefficients" and "vascular density" were considered and calculated. Severity scales were developed for semi-quantitative OCT features of "disruption of collagen" and "vascular asset," while extent scales were produced for semi-quantitative RCM "irregular honeycomb," "mottled pigmentation" and "polycyclic papillary contours." Qualitative assessment was obtained for RCM type of collagen, and comparison between age groups was performed for all features considered. Severity visual scales assistance proved excellent inter-rater agreement across all semi-quantitative and qualitative domains. The assistance of shareable software systems allows for objective OCT quantitative parameters measurement. The use of standard reference scales, within a defined assessment methodology, offers high inter-rater reliability and thus reproducibility for semi-quantitative and qualitative OCT and RCM parameters. Taken together, our results may represent a starting point for a standardized application of RCM and OCT in dermo-cosmetic research and practice.
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Affiliation(s)
- Silvana Ciardo
- Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudia Pezzini
- Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefania Guida
- Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Ester Del Duca
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Dermatology, University Magna Graecia, Catanzaro, Italy
| | - Jonathan Ungar
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marco Manfredini
- Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Caterina Longo
- Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy.,Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Giovanni Pellacani
- Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy.,Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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12
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Persechino F, Ranieri D, Guttieri L, Nanni M, Torrisi MR, Belleudi F. Expression Profile of Fibroblast Growth Factor Receptors, Keratinocyte Differentiation Markers, and Epithelial Mesenchymal Transition-Related Genes in Actinic Keratosis: A Possible Predictive Factor for Malignant Progression? BIOLOGY 2021; 10:biology10040331. [PMID: 33920760 PMCID: PMC8071104 DOI: 10.3390/biology10040331] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/13/2022]
Abstract
Simple Summary In this work, we checked the modulation of Fibroblast Growth Factor Receptors (FGFRs) along with differentiation-related and epithelial-to-mesenchymal transition (EMT)-related markers to identify expression profiles that could be predictive for actinic keratosis (AK) progression through the “differentiated” pathway. We found that the downregulation of the analyzed differentiation markers, but not the modulation of the EMT-related markers, correlated with the canonical progression of AK. In addition, the observed modulation of FGFR2 mesenchymal/epithelial isoforms compatible with FGFR2 isoform switch, as well as the upregulation of FGFR4 suggested their correlation with early steps of AK pathogenesis. In contrast, the increase of mesenchymal FGFR3c isoform expression appeared to suggest that this event correlated with late steps of AK progression. In addition, the strong modulation of filaggrin (FIL), Snail1, as well as of FGFR2c, FGFR4, and their ligand Fibroblast Growth Factor 2 (FGF2), observed in some of the keratinocytic intraepithelial neoplasia grade I (KIN I) samples, may indicate that they could be molecular markers predictive for those KIN I lesions destined to a direct progression to squamous cell carcinoma (SCC) through the “differentiated” pathway. Abstract Actinic keratosis (AK) is the ultra violet (UV)-induced preneoplastic skin lesion clinically classified in low (KIN I), intermediate (KIN II), and high (KIN III) grade lesions. In this work we analyzed the expression of Fibroblast Growth Factor Receptors (FGFRs), as well as of keratinocyte differentiation and epithelial-to-mesenchymal transition (EMT)-related markers in differentially graded AK lesions, in order to identify specific expression profiles that could be predictive for direct progression of some KIN I lesions towards squamous cell carcinoma (SCC). Our molecular analysis showed that the keratinocyte differentiation markers keratin 1 (K1), desmoglein-1 (DSG1), and filaggrin (FIL) were progressively downregulated in KIN I, II, and III lesions, while the modulation of epithelial/mesenchymal markers and the induction of the transcription factors Snail1 and Zinc finger E-box-binding homeobox 1 (ZEB1) compatible with pathological EMT, even if observable, did not appear to correlate with AK progression. Concerning FGFRs, a modulation of epithelial isoform of FGFR2 (FGFR2b) and the mesenchymal FGFR2c isoform compatible with an FGFR2 isoform switch, as well as FGFR4 upregulation were observed starting from KIN I lesions, suggesting that they could be events involved in early steps of AK pathogenesis. In contrast, the increase of FGFR3c expression, mainly appreciable in KIN II and KIN III lesions, suggested a correlation with AK late progression. Interestingly, the strong modulation of FIL, Snail1, as well as of FGFR2c, FGFR4, and of their ligand FGF2, observed in some of the KIN I samples, may indicate that they could be molecular markers predictive for those low graded lesions destined to a direct progression to SCC. In conclusion, our data point on the identification of molecular markers predictive for AK rapid progression through the “differentiated” pathway. Our results also represent an important step that, in future, will help to clarify the molecular mechanisms underlying FGFR signaling deregulation in epithelial tissues during the switch from the pre-neoplastic to the oncogenic malignant phenotype.
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Affiliation(s)
- Flavia Persechino
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (F.P.); (D.R.); (L.G.); (M.R.T.)
| | - Danilo Ranieri
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (F.P.); (D.R.); (L.G.); (M.R.T.)
| | - Luisa Guttieri
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (F.P.); (D.R.); (L.G.); (M.R.T.)
| | - Monica Nanni
- Tissue Biology Research Unit, Department of Surgery, University Children’s Hospital, CH–8032 Zurich, Switzerland;
| | - Maria Rosaria Torrisi
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (F.P.); (D.R.); (L.G.); (M.R.T.)
- S. Andrea University Hospital, 00100 Rome, Italy
| | - Francesca Belleudi
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (F.P.); (D.R.); (L.G.); (M.R.T.)
- Correspondence:
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13
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Clinical Applications of In Vivo and Ex Vivo Confocal Microscopy. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11051979] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Confocal laser scanning microscopy (CLSM) has been introduced in clinical settings as a tool enabling a quasi-histologic view of a given tissue, without performing a biopsy. It has been applied to many fields of medicine mainly to the skin and to the analysis of skin cancers for both in vivo and ex vivo CLSM. In vivo CLSM involves reflectance mode, which is based on refractive index of cell structures serving as endogenous chromophores, reaching a depth of exploration of 200 μm. It has been proven to increase the diagnostic accuracy of skin cancers, both melanoma and non-melanoma. While histopathologic examination is the gold standard for diagnosis, in vivo CLSM alone and in addition to dermoscopy, contributes to the reduction of the number of excised lesions to exclude a melanoma, and to improve margin recognition in lentigo maligna, enabling tissue sparing for excisions. Ex vivo CLSM can be performed in reflectance and fluorescent mode. Fluorescence confocal microscopy is applied for “real-time” pathological examination of freshly excised specimens for diagnostic purposes and for the evaluation of margin clearance after excision in Mohs surgery. Further prospective interventional studies using CLSM might contribute to increase the knowledge about its application, reproducing real-life settings.
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14
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Ho YH, Pan Y, Sun CK, Liao YH. Presence of intralesional melanocytes as a histopathological feature of actinic keratosis based on in vivo harmonic generation microscopy in Asians. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2021; 37:20-27. [PMID: 33476066 DOI: 10.1111/phpp.12595] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/04/2020] [Accepted: 07/16/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Most patients with actinic keratosis (AK) present with more than one lesion. Although histopathological examination is the gold standard for diagnosing this condition, performing an invasive skin biopsy for each AK is impractical. Thus, this study aimed to identify AK's morphological characteristics based on harmonic generation microscopy (HGM). Moreover, the correlation between features observed using HGM and histopathological grading of AK was examined. METHODS Lesions of seven patients were examined using HGM (n = 1, ex vivo and n = 6, in vivo), and histopathological examinations of the biopsy specimens were also performed. The features of each AK, based on HGM, were assessed and compared with corresponding standard histopathological findings. RESULTS Using the histopathological findings as a standard reference, HGM's accuracy in detecting features of AK lesions, such as hyperkeratosis, epidermal thinning, abnormal architecture, and atypical honeycomb pattern, was 100%. Approximately five (72%) patients had similar histopathological grades. Moreover, based on HGM, except for one patient with grade 1 AK, six (85.71%) patients had lesions with intraepidermal dendritic cell-like cells, representing melanocytes. CONCLUSION Harmonic generation microscopy can be used in vivo to provide critical diagnostic information with a resolution comparable to histopathological examination. In addition, intralesional melanocytes in AK, which may be correlated with disease severity, can be specifically enhanced using HGM.
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Affiliation(s)
- Yi-Hsin Ho
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi Pan
- Graduate Institute of Photonics and Optoelectronics and Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Chi-Kuang Sun
- Graduate Institute of Photonics and Optoelectronics and Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan.,Molecular Imaging Center and Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Yi-Hua Liao
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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15
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Combalia A, Carrera C. Squamous Cell Carcinoma: An Update on Diagnosis and Treatment. Dermatol Pract Concept 2020; 10:e2020066. [PMID: 32642314 DOI: 10.5826/dpc.1003a66] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2020] [Indexed: 01/11/2023] Open
Abstract
Squamous cell carcinoma (SCC) accounts for most nonmelanoma skin cancer-related metastatic disease and deaths. Histopathology and correct surgical excision remain the gold standard for the diagnosis and treatment of SCC; however, new diagnostic imaging techniques such as dermoscopy and reflectance confocal microscopy have increased the diagnostic accuracy in terms of early recognition, better differential diagnosis, more precise selection of areas to biopsy, and noninvasive monitoring of treatments. The therapeutic intervention in patients with severe actinic damage and multiple in situ/low-risk SCC, and the development of innovative treatments such as epidermal growth factor receptor inhibitors and immune checkpoint inhibitors for locally advanced and metastatic SCC, are improving considerably the approach to the disease. This review summarizes the up-to-date knowledge in the field of detection, treatment, and monitoring of cutaneous SCC.
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Affiliation(s)
- Andrea Combalia
- Dermatology Department, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Cristina Carrera
- Dermatology Department, University of Barcelona, Hospital Clínic de Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto Carlos III, Barcelona, Spain
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16
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Mota ANCM, De Carvalho N, Pellacani G, de Faria PCP, Melo DF, Pineiro-Maceira JM, Barcaui CB. Reflectance confocal microscopy in actinic keratosis-Comparison of efficacy between cryotherapy protocols. Skin Res Technol 2020; 26:876-882. [PMID: 32592215 DOI: 10.1111/srt.12889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/30/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Actinic keratosis (AK) incidence is increasing. Due to the risk of progression to squamous cell carcinoma, early detection and treatment are essential. The method stated in the European Consensus is cryotherapy, but there is no standard protocol defined for better results. OBJECTIVES To compare two different cryotherapy protocols for AK using reflectance confocal microscopy (RCM) as a noninvasive imaging method for evaluation. METHODS A self-controlled clinical trial was proposed to compare the efficacy of cryotherapy in two different application protocols. Grade II AKs in the forearms were submitted to freezing and thawing time of 10 seconds for 1 cycle (group A) or 2 cycles (group B). At baseline and 4 weeks after treatment, the same dermatologists assessed RCM evaluation (thickness of horny layer, parakeratosis, dyskeratosis, atypia in spinous layer, fibrosis, and presence of inflammatory cells in epidermis and dermis). RESULTS We examined 24 AK lesions in each group. Statistical evaluation of the results evidenced superior response after 2 cycles of cryotherapy in parakeratosis and number of inflammatory cells in epidermis. CONCLUSION Both protocols are effective in clearing clinical AK. Two cycles are not generating more side effects (fibrosis) and could reduce the risk of recurrence (better "clearance" of parakeratosis).
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Affiliation(s)
- Amanda Nascimento Cavalleiro Macedo Mota
- Dermatology Department, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.,Dermatology Departament, Central Aeronautics Hospital (HCA), Rio de Janeiro, Brazil
| | - Nathalie De Carvalho
- Dermatology Department, University of Modena and Reggio Emilia (UNIMORE), Modena, Italy.,Dermatology Department, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Giovanni Pellacani
- Dermatology Department, University of Modena and Reggio Emilia (UNIMORE), Modena, Italy
| | | | - Daniel Fernandes Melo
- Dermatology Department, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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17
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Nascimento Cavalleiro Macedo Mota A, Piñeiro-Maceira JM, Baptista Barcaui C. Evaluation of diagnostic criteria of actinic keratosis through reflectance confocal microscopy. Skin Res Technol 2020; 26:883-890. [PMID: 32585761 DOI: 10.1111/srt.12890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The diagnosis of actinic keratosis (AK) is based on clinical evaluation and confirmed by histopathological analysis (HA). The challenge is to establish the correct diagnosis with a minimally invasive assessment. The aim of this study is to validate the analysis of AK by reflectance confocal microscopy (RCM), a cellular resolution, noninvasive imaging method and to determine the relevant parameters for diagnosis, compared to HA, by calculating the sensitivity (S), specificity (E), positive predictive value (PPV), and negative predictive value (NPV) of each criterion. MATERIALS AND METHODS Through clinical examination, 25 AKs were selected for dermoscopy and RCM evaluation followed by shaving excision for HA. Statistical analysis was done by hypothesis tests (McNemar for binary and Wilcoxon for continuous variables). RESULTS There was no significant difference between RCM and HA for 5 of the 6 parameters analyzed. The criteria that were statistically relevant were as follows: parakeratosis (p-value 0.449690; S 90%; PPV 78.26%), hyperkeratosis (p-value 0.248213; S 87.5%; E 100%; PPV 100%; NPV 25%), dyskeratosis (p-value 0.617075; S 85.71%; E 75%; PPV 94.74%; NPV 50%), spinous layer keratinocyte atypia classified as mild, moderate or severe (P-value 0.145032) and inflammation in epidermis (P-value 1.000000; S 75%; E 20%; PPV 78.95%; NPV 16.67%). RCM could not adequately measure inflammation in dermis (P-value 0.013328), despite good sensitivity (68%) and PPV (100%). CONCLUSION RCM proved to be an effective method for the diagnosis of AK, contributing to the selection of the most appropriate treatment option.
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Affiliation(s)
- Amanda Nascimento Cavalleiro Macedo Mota
- Department of Dermatology, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.,Department of Dermatology, Aviation Central Hospital (HCA), Rio de Janeiro, Brazil
| | | | - Carlos Baptista Barcaui
- Department of Dermatology, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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18
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Persechino F, Franceschini C, Iorio A, Carbone A, Ferrari A, Buccini P, Piemonte P, Eibenschutz L, Sperduti I, Cota C, Frascione P, Ardigo M. Clinical management of very small pigmented lesions: Improved clinical outcome through dermoscopy and reflectance confocal microscopy combination. Skin Res Technol 2020; 26:718-726. [PMID: 32207544 DOI: 10.1111/srt.12863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/29/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Small-sized pigmented lesions (SSPL) <3 mm in diameter are common pitfall in the daily dermatology practice. Dermoscopy alone is hampered by the lack of specific features inversely proportional to the diameter of the lesions and its performance is highly operator-dependent. Reflectance confocal microscopy (RCM) has been demonstrated to be effective in the diagnosis of several difficult lesions where dermoscopy lacks to provide conclusive information. MATERIALS AND METHODS A total of 179 lesions with uncertain or equivocal clinical and dermoscopy appearance were selected. Dermoscopist has been requested to express a diagnostic suspect when possible. Equivocal lesions underwent RCM performed by expert for second-level evaluation before surgical excision for histological diagnosis. Results have been later statistically analysed. RESULTS Dermoscopy was not diagnostic in large number of lesions with low concordance histology (39.1%) instead of a much high concordance when combined with RCM (93.9%). CONCLUSIONS Small-sized pigmented lesions were more likely to be located on the face area. Diagnosis of pigmented BCC was relatively easy on dermoscopy and also in the case of small lesions showing typical signs of BCC. LM and MM have been seen to be particularly difficult to be diagnosed using only dermoscopy. The combination of digital dermoscopy and RCM represents the correct approach of SSPL.
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Affiliation(s)
- Flavia Persechino
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Clinical Dermatology, San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Chiara Franceschini
- Clinical Dermatology, San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Alessandra Iorio
- Oncologic and Preventative Dermatology, IFO-San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Anna Carbone
- Oncologic and Preventative Dermatology, IFO-San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Angela Ferrari
- Oncologic and Preventative Dermatology, IFO-San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Pierluigi Buccini
- Oncologic and Preventative Dermatology, IFO-San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Paolo Piemonte
- Oncologic and Preventative Dermatology, IFO-San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Laura Eibenschutz
- Oncologic and Preventative Dermatology, IFO-San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Isabella Sperduti
- Biostatistical Unit, Scientific Direction, San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Carlo Cota
- Dermatopathology Laboratory, San Gallicano Dermatological Institute, Rome, Italy
| | - Pasquale Frascione
- Oncologic and Preventative Dermatology, IFO-San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Marco Ardigo
- Clinical Dermatology, San Gallicano Dermatological Institute-IRCCS, Rome, Italy
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Benati E, Longhitano S, Pampena R, Mirra M, Raucci M, Pellacani G, Longo C. Digital follow‐up by means of dermatoscopy and reflectance confocal microscopy of actinic keratosis treated with Imiquimod 3.75% cream. J Eur Acad Dermatol Venereol 2020; 34:1471-1477. [DOI: 10.1111/jdv.16143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/21/2019] [Indexed: 12/14/2022]
Affiliation(s)
- E. Benati
- Centro Oncologico ad Alta Tecnologia Diagnostica Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia Reggio Emilia Italy
| | - S. Longhitano
- Dermatology Department University of Modena and Reggio Emilia Modena Italy
| | - R. Pampena
- Centro Oncologico ad Alta Tecnologia Diagnostica Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia Reggio Emilia Italy
| | - M. Mirra
- Centro Oncologico ad Alta Tecnologia Diagnostica Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia Reggio Emilia Italy
| | - M. Raucci
- Centro Oncologico ad Alta Tecnologia Diagnostica Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia Reggio Emilia Italy
| | - G. Pellacani
- Dermatology Department University of Modena and Reggio Emilia Modena Italy
| | - C. Longo
- Centro Oncologico ad Alta Tecnologia Diagnostica Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia Reggio Emilia Italy
- Dermatology Department University of Modena and Reggio Emilia Modena Italy
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20
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Agozzino M, Russo T, Franceschini C, Mazzilli S, Garofalo V, Campione E, Bianchi L, Milani M, Argenziano G. Effects of topical piroxicam and sun filters in actinic keratosis evolution and field cancerization: a two-center, assessor-blinded, clinical, confocal microscopy and dermoscopy evaluation trial. Curr Med Res Opin 2019; 35:1785-1792. [PMID: 31148490 DOI: 10.1080/03007995.2019.1626227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Actinic keratosis (AK) is considered an "in situ" non-melanoma skin cancer induced by ultraviolet chronic exposure. Sunscreen and topical anti-inflammatory agents like diclofenac could improve the evolution of this kind of lesions. A topical product containing piroxicam 0.8% and sun filters (50 SPF) (ACTX) has been shown to be very effective in reducing AK lesions. So far, no data are available regarding the effects of this product on skin modifications evaluated by reflectance confocal microscopy (RCM) and dermoscopy at the lesion sites and on the skin around the lesions (field cancerization). Study aim: To evaluate in a two-center, assessor-blinded, prospective trial the effect of ACTX on AK number, RCM and dermoscopy parameter evolution of a target lesion in subjects with multiple AK lesions. Subjects and methods: A total of 54 subjects (42 men and 12 women; mean age 65 years) with AK lesions grade I-III located on the scalp (n = 36) or face (n = 18) were enrolled after their written informed consent. ACTX was applied twice daily on the face and scalp for six consecutive months. AK lesion count was performed at baseline and after 3 and 6 months. Lesion count was assessed in a blind fashion evaluating digital color high definition images performed at each visit and coded in a blinded fashion. RCM evaluations were performed at the same time-points. A dermoscopy evaluation was performed at baseline and after 6 months. RCM and dermoscopy were assessed on a pre-specified target lesion. The RCM severity score was used evaluating 11 items, examining stratum corneum, stratum granulosum, stratum spinous and dermal layers (maximum score 11 points). The dermoscopy score evaluated erythema, scaling and follicular plugs (from 0 to 4 for each item) and pigmentation (from 0 to 5). Results: Forty-nine subjects (90%) concluded the trial. At baseline, the mean (SD) number of AK lesions was 9.6 (5.2). AK lesions significantly decreased to 5.9 and to 5.6 after 3 and 6 months of ACTX treatment (p = .001; intention to treat analysis), representing a -42% reduction. A reduction of AK lesion numbers >50% in comparison with baseline was observed in 51% of subjects at month 6. New AK lesions appeared in five subjects (9%). The RCM mean (SD) severity score at baseline was 6.4 (2.0). ACTX treatment was associated with a progressive and significant (p = .002) reduction to 4.9 after 3 months and to 4.8 (2.3) at month 6 (a -25% reduction). The dermoscopy score at baseline was 5.5 (2) and it was reduced significantly (p = .007) to 4.5 (2) at the end of the study. The product was in general very well tolerated. Conclusion: A 6 month application of ACTX in subjects with AK lesions was associated with an improvement in AK lesion count and with a reduction in the RCM/dermoscopy severity scores of the target lesion. Trial registration number: ISRCTN22070974.
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Affiliation(s)
- Marina Agozzino
- Dermatology Unit, University of Campania Luigi Vanvitelli , Naples , Italy
| | - Teresa Russo
- Dermatology Unit, University of Campania Luigi Vanvitelli , Naples , Italy
| | | | - Sara Mazzilli
- Dermatology Clinic Tor Vergata University Rome , Rome , Italy
| | | | - Elena Campione
- Dermatology Clinic Tor Vergata University Rome , Rome , Italy
| | - Luca Bianchi
- Dermatology Clinic Tor Vergata University Rome , Rome , Italy
| | - Massimo Milani
- Cantabria Labs, Difa Cooper Caronno P , Caronno Pertusella , Italy
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22
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Pellacani G, Longo C. Reflectance confocal microscopy: a crucial role for actinic keratosis treatment monitoring. J Eur Acad Dermatol Venereol 2018; 32:1055. [PMID: 29846971 DOI: 10.1111/jdv.15091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - C Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
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23
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Combalia A, Fustà-Novell X, Alejo B, Domínguez M, Barreiro A, Carrera C. Actinic Keratosis—Can Dermoscopy or RCM Differentiate AK (Not Full Thickness Atypia) from Full-Thickness Atypia/Invasive SCC? CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0219-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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24
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Pezzini C, Mandel VD, Persechino F, Ciardo S, Kaleci S, Chester J, De Carvalho N, Persechino S, Pellacani G, Farnetani F. Seborrheic keratoses mimicking melanoma unveiled by in vivo reflectance confocal microscopy. Skin Res Technol 2018; 24:285-293. [PMID: 29363175 DOI: 10.1111/srt.12427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Seborrheic keratoses (SebK) with atypical dermoscopy presentation are increasingly reported. These lesions do not exhibit typical dermoscopy features of SebK and sometimes mimic melanoma, thus complicating the differential diagnosis. Reflectance confocal microscopy (RCM) is a non-invasive tool, which allows an in vivo imaging of the skin. The study objectives were to evaluate the agreement between RCM classification and histological diagnoses, and the reliability of well-known RCM criteria for SebK in the identification of SebK with atypical dermoscopy presentation. MATERIALS AND METHODS We retrospectively analysed at RCM excised lesions presenting in dermoscopy ≥1 score at revisited 7-point checklist. The study population consisted of cases showing no melanocytic RCM findings. Lesions were investigated for distinct non-melanocytic RCM features, blinded from histopathology diagnoses. Histopathology matching was then performed before statistical analysis. RESULTS The study consisted of 117 cases, classified at RCM as SebK (71 cases), dermatofibroma (18 cases), basal cell carcinoma (13 cases), squamous cell carcinoma (2 cases), and "non-specific" (13 cases). Overall K strength of agreement at histopathology matching proved 0.76. Of the 71 cases classified at RCM with SebK, agreement was achieved in 97%. CONCLUSION Reflectance confocal microscopy classification proved high agreement with histopathology for SebK with atypical dermoscopy presentations, allowing an early differential diagnosis. RCM features in this group of lesions were similar to those described for typical cases of SebK, and may assist clinician therapy decision making, whilst avoiding unnecessary excisions.
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Affiliation(s)
- C Pezzini
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - V D Mandel
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - F Persechino
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - S Ciardo
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - S Kaleci
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - J Chester
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - N De Carvalho
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - S Persechino
- Dermatology Unit, NESMOS Department, S. Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - G Pellacani
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - F Farnetani
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Pampena R, Benati E, Borsari S, Bombonato C, Lombardi M, Raucci M, Mirra M, Lallas A, Apalla Z, Papadimitriou I, Moscarella E, Kyrgidis A, Argenziano G, Pellacani G, Longo C. Tracking actinic keratosis of face and scalp treated with 0.015% ingenol mebutate to identify clinical and dermoscopic predictors of treatment response. J Eur Acad Dermatol Venereol 2018; 32:1461-1468. [PMID: 29356164 DOI: 10.1111/jdv.14803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 01/03/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ingenol mebutate (IngMeb) 0.015% gel is an approved field treatment option for non-hyperkeratotic non-hypertrophic actinic keratosis (AK) of face and scalp. Efficacy of IngMeb has been assessed only on a clinical ground, in the majority of studies. Dermoscopy is a pivotal tool for the diagnosis of AK, while its role in evaluating the response to non-surgical therapies for AK has not been fully defined. OBJECTIVES Our study aims to determine whether some dermoscopic features of AK of the face and scalp areas may independently predict the response to IngMeb therapy. METHODS Clinical and dermoscopic responses, 1 month after 0.015% IngMeb therapy, were retrospectively evaluated using a per-patient and per-lesion approach. Safety was evaluated through local skin reaction composite score calculation. Demographic, clinical and dermoscopic factors were then evaluated via univariate and multivariate logistic regression analysis to assess independent predictors of response. RESULTS Fifty-five patients with 245 AKs were enrolled. Clinically, per-patient response evaluation identified 25 (45.4%) poor/partial and 30 (54.5%) complete responders, corresponding on a per-lesion approach to 66 (26.9%) and 179 (73.1%) AKs, respectively. Dermoscopy reclassified 14 patients in the per-patient and 48 AKs in the per-lesion analysis from complete to poor/partial responders. Multivariate logistic regression analysis showed that AKs dermoscopically characterized by red pseudonetwork and located on the face were independently associated with a complete dermoscopic response to 0.015% IngMeb therapy, while microerosions were negative predictors. CONCLUSION Specific dermoscopic features of AK may predict the response to 0.015% IngMeb therapy, together with the location on the face.
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Affiliation(s)
- R Pampena
- Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - E Benati
- Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - S Borsari
- Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - C Bombonato
- Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - M Lombardi
- Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - M Raucci
- Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - M Mirra
- Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - A Lallas
- First Department of Dermatology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Z Apalla
- First Department of Dermatology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - I Papadimitriou
- First Department of Dermatology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Moscarella
- Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - A Kyrgidis
- Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania, Naples, Italy
| | - G Pellacani
- Dermatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - C Longo
- Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.,Dermatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy
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26
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Casari A, Chester J, Pellacani G. Actinic Keratosis and Non-Invasive Diagnostic Techniques: An Update. Biomedicines 2018; 6:biomedicines6010008. [PMID: 29316678 PMCID: PMC5874665 DOI: 10.3390/biomedicines6010008] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/26/2017] [Accepted: 12/19/2017] [Indexed: 12/15/2022] Open
Abstract
Actinic keratosis represents the earliest manifestation of non-melanoma skin cancer. Because of their risk of progression to invasive squamous cell carcinoma, an earlier diagnosis and treatment are mandatory. Their diagnosis sometimes could represent a challenge even for expert dermatologists. Dermoscopy, confocal laser microscopy and optical coherence tomography could help clinicians in diagnosis.
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Affiliation(s)
- Alice Casari
- Clinica Dermatologica, Policlinico di Modena, Via del Pozzo 70, 41124 Modena, Italy.
| | - Johanna Chester
- Clinica Dermatologica, Policlinico di Modena, Via del Pozzo 70, 41124 Modena, Italy.
| | - Giovanni Pellacani
- Clinica Dermatologica, Policlinico di Modena, Via del Pozzo 70, 41124 Modena, Italy.
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Figueras Nart I, Cerio R, Dirschka T, Dréno B, Lear JT, Pellacani G, Peris K, Ruiz de Casas A. Defining the actinic keratosis field: a literature review and discussion. J Eur Acad Dermatol Venereol 2017; 32:544-563. [PMID: 29055153 DOI: 10.1111/jdv.14652] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Despite the chronic and increasingly prevalent nature of actinic keratosis (AK) and existing evidence supporting assessment of the entire cancerization field during clinical management, a standardized definition of the AK field to aid in the understanding and characterization of the disease is lacking. The objective of this review was to present and appraise the available evidence describing the AK cancerization field, with the aim of determining a precise definition of the AK field in terms of its molecular (including genetic and immunological), histological and clinical characteristics. Eight European dermatologists collaborated to conduct a review and expert appraisal of articles detailing the characteristics of the AK field. Articles published in English before August 2016 were identified using PubMed and independently selected for further assessment according to predefined preliminary inclusion and exclusion criteria. In addition, a retrospective audit of patients with AK was performed to define the AK field in clinical terms. A total of 32 review articles and 47 original research articles provided evidence of sun-induced molecular (including genetic and immunological) and histological skin changes in the sun-exposed area affected by AK. However, the available literature was deemed insufficient to inform a clinical definition of the AK field. During the retrospective audit, visible signs of sun damage in 40 patients with AK were assessed. Telangiectasia, atrophy and pigmentation disorders emerged as 'reliable or very reliable' indicators of AK field based on expert opinion, whereas 'sand paper' was deemed a 'moderately reliable' indicator. This literature review has revealed a significant gap of evidence to inform a clinical definition of the AK field. Therefore, the authors instead propose a clinical definition of field cancerization based on the identification of visible signs of sun damage that are reliable indicators of field cancerization based on expert opinion.
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Affiliation(s)
- I Figueras Nart
- Department of Dermatology, Bellvitge Hospital, Barcelona, Spain
| | - R Cerio
- Department of Cutaneous Medicine and Surgery, The Royal London Hospital and QMUL, Bart's Health NHS Trust, London, UK
| | - T Dirschka
- CentroDerm® Clinic, Wuppertal, Germany.,Faculty of Health, University Witten-Herdecke, Witten, Germany
| | - B Dréno
- Department of Dermato-Cancerology, University of Nantes, Nantes, France
| | - J T Lear
- Manchester Academic Health Science Centre, MAHSC, Manchester University and Salford Royal NHS Foundation Trust, Royal Infirmary, The University of Manchester, Manchester, UK
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - K Peris
- Department of Dermatology, Catholic University of Rome, Rome, Italy
| | - A Ruiz de Casas
- Dermatology Unit, Virgen Macarena University Hospital, Seville, Spain
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Ulrich M, Reinhold U, Falqués M, Rodriguez Azeredo R, Stockfleth E. Use of reflectance confocal microscopy to evaluate 5-fluorouracil 0.5%/salicylic acid 10% in the field-directed treatment of subclinical lesions of actinic keratosis: subanalysis of a Phase III, randomized, double-blind, vehicle-controlled trial. J Eur Acad Dermatol Venereol 2017; 32:390-396. [DOI: 10.1111/jdv.14611] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 09/19/2017] [Indexed: 11/27/2022]
Affiliation(s)
- M. Ulrich
- CMB Collegium Medicum Berlin GmbH; Berlin Germany
| | - U. Reinhold
- Dermatological Center Bonn Friedensplatz; Bonn Germany
| | | | | | - E. Stockfleth
- Department of Dermatology; Ruhr-University; Bochum Germany
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29
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Manfredini M, Longo C, Ferrari B, Piana S, Benati E, Casari A, Pellacani G, Moscarella E. Dermoscopic and reflectance confocal microscopy features of cutaneous squamous cell carcinoma. J Eur Acad Dermatol Venereol 2017; 31:1828-1833. [PMID: 28696052 DOI: 10.1111/jdv.14463] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 06/22/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Squamous cell carcinoma (SCC) of the skin is a highly prevalent neoplasm. The management and the prognosis of this tumour are dependent on its invasiveness and its grade of differentiation. OBJECTIVES To evaluate whether specific dermoscopic and reflectance confocal microscopy (RCM) criteria can predict the diagnosis of invasive SCC vs. in situ SCC and poorly differentiated compared with well- and moderately differentiated SCC. METHODS Dermoscopic and RCM images of SCC were retrospectively evaluated for the presence of predefined criteria. RESULTS Among 143 SCCs, 121 cases had a complete set of images and thus were included in the study set. The head and neck area was the most frequently involved body site (74/121; 61.1%) followed by extremities (36/121, 29.7%) and trunk (11/121, 9.1%). Seventy tumours were in situ (57.8%), while 51 were invasive (42.1%), of these 11 were poorly differentiated (21.5%), 16 were moderately differentiated (31.3%), and 24 were well differentiated (47.0%). Chi-squared analysis demonstrated that invasive SCCs were characterized by polymorphic vessels, erosion/ulceration, architectural disarrangement, speckled nucleated cells in the dermis, irregularly dilated vessels and absence of hyperkeratosis. Buttonhole vessels, white structureless areas and dotted or glomerular vessels were significantly associated with in situ lesions. Poorly differentiated SCCs were typified by red areas, erosion/ulceration and architectural disarrangement. Well- or moderately differentiated SCCs were associated with white areas and speckled nucleated cells in the epidermis. CONCLUSION Clinical, dermoscopic and RCM images provide useful information that should be integrated in order to achieve the optimal therapeutic management for the patient.
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Affiliation(s)
- M Manfredini
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - C Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - B Ferrari
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - S Piana
- Pathology Unit, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - E Benati
- Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - A Casari
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - E Moscarella
- Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
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31
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32
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33
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Tan J, Lambie D, Sinnya S, Sahebian A, Soyer H, Prow T, Ardigò M. Histopathology and reflectance confocal microscopy features of photodamaged skin and actinic keratosis. J Eur Acad Dermatol Venereol 2016; 30:1901-1911. [DOI: 10.1111/jdv.13699] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 03/04/2016] [Indexed: 12/18/2022]
Affiliation(s)
- J.M. Tan
- Dermatology Research Centre; The University of Queensland; School of Medicine; Translational Research Institute; Brisbane Queensland Australia
| | - D. Lambie
- Dermatology Research Centre; The University of Queensland; School of Medicine; Translational Research Institute; Brisbane Queensland Australia
- IQ Pathology; Brisbane Queensland Australia
| | - S. Sinnya
- Dermatology Research Centre; The University of Queensland; School of Medicine; Translational Research Institute; Brisbane Queensland Australia
| | - A. Sahebian
- Dermatology Research Centre; The University of Queensland; School of Medicine; Translational Research Institute; Brisbane Queensland Australia
| | - H.P. Soyer
- Dermatology Research Centre; The University of Queensland; School of Medicine; Translational Research Institute; Brisbane Queensland Australia
| | - T.W. Prow
- Dermatology Research Centre; The University of Queensland; School of Medicine; Translational Research Institute; Brisbane Queensland Australia
| | - M. Ardigò
- San Gallicano Dermatological Institute; Rome Italy
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Seyed Jafari S, Timchik T, Hunger R. In vivoconfocal microscopy efficacy assessment of daylight photodynamic therapy in actinic keratosis patients. Br J Dermatol 2016; 175:375-81. [DOI: 10.1111/bjd.14517] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2016] [Indexed: 11/26/2022]
Affiliation(s)
- S.M. Seyed Jafari
- University Clinic for Dermatology, Inselspital, Bern University Hospital; 3010 Bern Switzerland
| | - T. Timchik
- University Clinic for Dermatology, Inselspital, Bern University Hospital; 3010 Bern Switzerland
| | - R.E. Hunger
- University Clinic for Dermatology, Inselspital, Bern University Hospital; 3010 Bern Switzerland
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