Soare Cristina, Cozma Elena Codruța, Giurcăneanu Călin, Voiculescu Vlad Mihai
Department of Dermato-Oncology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Department of Dermatology, "Elias" University Emergency Hospital, 011461 Bucharest, Romania.
Cancers (Basel). 2025 Sep 3;17(17):2899. doi: 10.3390/cancers17172899.
: Actinic keratosis (AK) is a common UV-induced intraepidermal neoplasm and a precursor to cutaneous squamous cell carcinoma (cSCC). Accurate, non-invasive assessment of AK severity is crucial for early intervention and risk stratification. Objective: To evaluate the relationship between clinical severity of AK, as defined by the Olsen grading scale, and predefined dermoscopic and reflectance confocal microscopy (RCM) features. : This cross-sectional study enrolled 50 patients with clinically diagnosed AK at a tertiary dermatology center between April 2024 and July 2025. Each lesion was assessed clinically using the Olsen scale (grades 1-3), dermoscopically (five features scored 0-3; total score 0-15), and via RCM (five RCM parameters scored 0-3; total score 0-15). Statistical correlations between clinical grade and imaging features were analyzed using Pearson's χ test with effect size metrics. : Diffuse erythema ( < 0.001), micro-erosions ( = 0.002), strawberry pattern ( = 0.038), and scales ( = 0.012) correlated significantly with Olsen grade, whereas vessels ( = 0.566) did not. All five RCM parameters showed strong associations with clinical severity. Composite dermoscopic and RCM scores correlated with Olsen grade (both < 0.001). Abnormal honeycomb pattern, parakeratosis, inflammation, and solar elastosis were the best RCM predictors of high dermoscopic severity (all < 0.001); conversely, erosions, erythema, and scales were the strongest dermoscopic predictors of high RCM severity (all < 0.001). : This study demonstrates strong, statistically significant associations between clinical, dermoscopic, and confocal features of AK. This supports the integration of multimodal scoring into unified AK severity frameworks.
光化性角化病（AK）是一种常见的紫外线诱导的表皮内肿瘤，也是皮肤鳞状细胞癌（cSCC）的前驱病变。准确、无创地评估AK的严重程度对于早期干预和风险分层至关重要。目的：评估由奥尔森分级量表定义的AK临床严重程度与预先定义的皮肤镜和反射式共聚焦显微镜（RCM）特征之间的关系。：这项横断面研究于2024年4月至2025年7月在一家三级皮肤科中心纳入了50例临床诊断为AK的患者。每个病变均使用奥尔森量表（1 - 3级）进行临床评估，通过皮肤镜（五个特征评分为0 - 3分；总分0 - 15分）以及通过RCM（五个RCM参数评分为0 - 3分；总分0 - 15分）进行评估。使用Pearson卡方检验及效应量指标分析临床分级与影像特征之间的统计相关性。：弥漫性红斑（<0.001）、微糜烂（=0.002）、草莓样图案（=0.038）和鳞屑（=0.012）与奥尔森分级显著相关，而血管（=0.566）则无相关性。所有五个RCM参数均与临床严重程度显示出强关联。综合皮肤镜和RCM评分与奥尔森分级相关（均<0.001）。异常蜂巢样图案、角化不全、炎症和日光性弹力纤维变性是皮肤镜高严重程度的最佳RCM预测指标（均<0.001）；相反，糜烂、红斑和鳞屑是RCM高严重程度最强的皮肤镜预测指标（均<0.001）。：本研究证明了AK的临床、皮肤镜和共聚焦特征之间存在强的、具有统计学意义的关联。这支持将多模式评分整合到统一的AK严重程度框架中。
