Ulrich M, Forschner T, Röwert-Huber J, González S, Stockfleth E, Sterry W, Astner S
Department of Dermatology, Charité, Skin Cancer Center Charité, University Hospital of Berlin, Berlin, Germany.
Br J Dermatol. 2007 May;156 Suppl 3:47-52. doi: 10.1111/j.1365-2133.2007.07862.x.
Clinical differentiation between actinic keratosis (AK) and disseminated superficial actinic porokeratosis (DSAP) may pose a significant challenge, and histological evaluation is often also required for diagnosis. Distinct morphological features can be distinguished upon histopathological examination, but the use of non-invasive tools, such as reflectance confocal microscopy (RCM), may be an eligible alternative for confirmation of diagnosis.
The aim of this study was to determine the relevant RCM criteria for the identification of disseminated superficial actinic porokeratoses (DSAPs) and to define distinguishing criteria for DSAPs compared with actinic keratosis (AKs).
PATIENTS/METHODS: A total of 20 patients with a clinical diagnosis of AK or DSAP were included in this study. All lesions were evaluated by clinical examination, and RCM and one clinically identified lesion was biopsied for histological confirmation.
Cellular and nuclear atypia, inflammation, spongiosis, parakeratosis and changes in epidermal architecture were present in both lesion types (i.e. AKs and DSAPs). However, these features were more pronounced in AKs. Whereas AKs exhibited more disseminated parakeratotic changes, parakeratosis was found focally present on the border of DSAP lesions. Most characteristically, a distinct border corresponding to cornoid lamella in RCM can be identified in DSAPs.
Distinguishing features of DSAPs, such as cornoid lamella, sharp demarcation of the lesion and focal keratinocyte atypia are easily identifiable using RCM, and correlate well with histopathology. Whilst RCM has previously been used in the evaluation of AKs, it has not yet been used to investigate DSAPs. The findings in this study suggest the feasibility of non-invasive tools, such as RCM for the differentiation of AKs and DSAPs. However, further studies are warranted to assess the sensitivity and specificity of RCM in the diagnosis of DSAP.
光化性角化病（AK）与播散性浅表性光化性汗孔角化症（DSAP）的临床鉴别可能具有重大挑战性，通常还需要进行组织学评估以明确诊断。组织病理学检查可区分出不同的形态学特征，但使用反射式共聚焦显微镜（RCM）等非侵入性工具可能是确诊的合适替代方法。
本研究旨在确定识别播散性浅表性光化性汗孔角化症（DSAP）的相关RCM标准，并明确DSAP与光化性角化病（AK）相比的鉴别标准。
患者/方法：本研究共纳入20例临床诊断为AK或DSAP的患者。所有皮损均通过临床检查进行评估，并采用RCM检查，同时对1个经临床确诊的皮损进行活检以进行组织学确认。
两种皮损类型（即AK和DSAP）均存在细胞和核异型性、炎症、海绵形成、不全角化及表皮结构改变。然而，这些特征在AK中更为明显。AK表现出更广泛的不全角化改变，而DSAP皮损边界处可见局灶性不全角化。最具特征性的是，在DSAP中可在RCM下识别出与鸡眼样板相对应的清晰边界。
使用RCM可轻松识别DSAP的特征性表现，如鸡眼样板、皮损的清晰分界及局灶性角质形成细胞异型性，且与组织病理学结果相关性良好。虽然RCM此前已用于AK的评估，但尚未用于研究DSAP。本研究结果表明，RCM等非侵入性工具可用于AK和DSAP的鉴别。然而，有必要进一步研究以评估RCM诊断DSAP的敏感性和特异性。
