Malvehy Josep, Roldán-Marín Rodrigo, Iglesias-García Pablo, Díaz Alba, Puig Susana
Melanoma Unit, Dermatology Department, Hospital Clinic, ES-08036 Barcelona,, Spain.
Acta Derm Venereol. 2015 Jan;95(1):45-50. doi: 10.2340/00015555-1860.
Visual inspection may fail to accurately evaluate field cancerisation (subclinical actinic keratoses [AKs]). We aimed to describe field cancerisation by confocal reflectance microscopy and changes induced by the application of 3% diclofenac sodium gel in 2.5% hyaluronic acid. Fourteen male patients, > 50 years old, with AKs on the bald scalp were included. Clinical examination, confocal microscopy and histological study of clinically visible lesions and "normal appearing" adjacent skin before and after treatment was completed. Reflectance confocal microscopy showed a decrease in scaling (p = 0.001) and atypia of the honeycomb pattern (p = 0.001) at 2 weeks of treatment. Changes in parakeratosis, inflammation and dermal collagen remodelling were also observed. Histology correlated with confocal features in AK and subclinical AK. Reflectance confocal microscopy was useful in the evaluation of field cancerisation and monitoring of treatment response. A rapid improvement in epidermal atypia was observed.
肉眼检查可能无法准确评估场癌化（亚临床光化性角化病[AKs]）。我们旨在通过共聚焦反射显微镜描述场癌化情况，以及应用含2.5%透明质酸的3%双氯芬酸钠凝胶所引起的变化。纳入了14名年龄大于50岁、秃头皮上患有AKs的男性患者。在治疗前后，对临床可见病变及“外观正常”的相邻皮肤进行了临床检查、共聚焦显微镜检查和组织学研究。反射式共聚焦显微镜显示，治疗2周时鳞屑减少（p = 0.001），蜂巢状模式的异型性降低（p = 0.001）。还观察到角化不全、炎症和真皮胶原重塑的变化。组织学与AK和亚临床AK中的共聚焦特征相关。反射式共聚焦显微镜有助于评估场癌化和监测治疗反应。观察到表皮异型性迅速改善。
