应用5-氨基酮戊酸后使用紫外线诱导荧光皮肤镜评估场癌化和光化性角化病——一项观察性研究

Assessing field cancerization and actinic keratosis using ultraviolet-induced fluorescence dermatoscopy after the application of 5-aminolevulinic acid - An observational study.

作者信息

Korecka Katarzyna, Polańska Adriana, Dańczak-Pazdrowska Aleksandra, Navarrete-Dechent Cristian

机构信息

Department of Dermatology, Poznań University of Medical Sciences, Przybyszewskiego 49, Poznań 60-356, Poland.

出版信息

Photodiagnosis Photodyn Ther. 2024 Apr;46:104056. doi: 10.1016/j.pdpdt.2024.104056. Epub 2024 Mar 19.

DOI:10.1016/j.pdpdt.2024.104056

PMID:38513809

Abstract

BACKGROUND

Actinic keratoses (AK) are one of the most frequent reasons for consultations in dermatology. Ultraviolet-induced fluorescence dermatoscopy (UVFD) is a new method that allows the assessment of lesions in a spectrum of light that originates from the fluorochromes emitting UV-excited luminescence. The aim of this study was to assess the UVFD features of AKs before PDT and their intensity in field cancerization and single lesions.

METHODS

This retrospective study was conducted from June to November 2023. Lesions were assessed with the Olsen scale clinically and dermatoscopically (DermLite DL5, 10x magnification) and photographed. UVFD fluorescence was categorized as 'none', 'weak', 'moderate', and 'intense'. A 1-mm thick layer of 10 % 5-ALA gel was applied to single lesions or cancerization field (depending on the patient) and covered with an occlusive dressing for 3 h. Prior the application of 10 % 5-ALA gel, the lesions were degreased with an alcoholic solution. The occlusion was removed, and the field was cleaned with a 0,9 % saline solution. Afterward, each lesion was photographed in polarized light and UVFD mode.

RESULTS

A total of 194 dermatoscopic images were analyzed, 111 corresponded to field cancerization and 81 to single AKs. Overall, weak fluorescence was noticed in 22 of them (11,3 %), moderate in 107 (55,15 %), and intense in 65 (33,5 %). Amongst field cancerization (111 images), weak fluorescence was seen in 11 (9.9 %), moderate in 68 (61,26 %), and intense in 32 (28,82 %). In single lesions (81 images), weak fluorescence was detected in 11 (13,2 %), moderate in 39 (46,99 %), and intense in 33 (28.83 %) of the lesions. Slightly more intense fluorescence was noticed in higher Olsen grade (p = 0.04).

CONCLUSIONS

UVFD can enhance our efficacy of pre-procedural examination and might arise as a useful device to predict the therapeutic effect of PDT.

摘要

背景

光化性角化病（AK）是皮肤科门诊最常见的就诊原因之一。紫外线诱导荧光皮肤镜检查（UVFD）是一种新方法，可在源于发出紫外线激发荧光的荧光染料的光谱中评估病变。本研究的目的是评估光动力疗法（PDT）前AK的UVFD特征及其在皮肤癌前病变场和单个病变中的强度。

方法

本回顾性研究于2023年6月至11月进行。临床和皮肤镜检查（DermLite DL5，10倍放大）评估病变并拍照。UVFD荧光分为“无”、“弱”、“中度”和“强”。将1毫米厚的10% 5-氨基酮戊酸（5-ALA）凝胶涂抹于单个病变或癌前病变场（取决于患者），并用封闭敷料覆盖3小时。在涂抹10% 5-ALA凝胶之前，用酒精溶液对病变进行脱脂处理。去除封闭敷料，并用0.9%的盐溶液清洁病变场。之后，在偏振光和UVFD模式下拍摄每个病变的照片。

结果

共分析了194张皮肤镜图像，其中111张对应皮肤癌前病变场，81张对应单个AK。总体而言，其中22张（11.3%）出现弱荧光，107张（55.15%）出现中度荧光，65张（33.5%）出现强荧光。在皮肤癌前病变场（111张图像）中，11张（9.9%）出现弱荧光，68张（61.26%）出现中度荧光，32张（28.82%）出现强荧光。在单个病变（81张图像）中，11张（13.2%）检测到弱荧光，39张（46.99%）出现中度荧光，33张（28.83%）出现强荧光。在较高的奥尔森分级中观察到稍强的荧光（p = 0.04）。