1. Clinical, dermatoscopical and histopathological correlation of atypical actinic keratoses
ID21905
Alise Balcere1, Raimonds Karls, Māris Sperga1, Māra Rone Kupfere1, Ingrīda Čēma2, Ludmila Vīksna1, Angelika Krūmiņa1
1Department of Infectiology and Dermatology, Riga Stradiņš University, Latvia
2Department of Oral Medicine, Riga Stradiņš University, Latvia
Introduction
Results
Actinic keratoses (AKs) are common mainly clinically diagnosed lesions on chronically sun exposed skin of fair skinned individuals. If these lesions are compared to melanocytic skin lesions, then in case of the latter it is generally accepted that a lesion which clinically or dermatoscopically differs from others, also known as “ugly duckling sign” 1, is more probable a melanoma. In case of AK a lesion which differs from others might be further in transition into invasive squamous cell carcinoma.
In total 15 patients were examined. In 10 patients 11 clinically and/or dermatoscopically different lesions were detected. All 10 patients agreed to a skin biopsy. Patients’ age ranged from 70 to 87 years (mean  standard deviation: 79.55.5) and lesion count ranged from 8 to 45 lesions (2111). In clinically atypical lesions (n=8) main clinical signs that marked the selected lesions were greater size (4 cases), more intense erythema (4 cases) and increased keratosis (4 cases). In half of these lesions additional atypical dermatoscopic features were present – glomerular vessels (2 cases), hairpin vessels (2 cases), radial lines (1 case), superficial erosions (1 case) and homogenous white areas (1 case). In dermatoscopically selected cases (n=3) hairpin vessels (2 cases), superficial erosions (2 cases) and white homogenous areas (1 case) were present. Histopathological examination was consistent with AK in all cases. From clinically atypical lesions 2 were grade I, 4 were grade II and 2 were grade III, while from dermatoscopically atypical lesions 3 were grade II and 4 were grade III. This difference of distribution (figure 2.) with higher histological grade in dermatoscopically atypical lesions in comparison with solely clinically atypical lesions was statistically significant (U=3.0, p=0.03, Mann-Whitney U test).
Aim of the study
We sought to carefully clinically and dermatoscopically examine patients with AK to assess the presence of lesions that differ from others, but still meet the clinical description of AK, and to describe their dermatoscopic and histopathologic correlations.
Materials and methods
Elderly patients with multiple AKs on facial skin were clinically and dermatoscopically examined by a board-certified dermatologist. If a clinically or dermatoscopically different lesion was diagnosed, then a digital dermatoscopy and 4 mm punch biopsy was performed. Clinical signs that marked suspicious lesions were increased erythema, size or hyperkeratosis. Dermatoscopically data on surface characteristics and vascular patterns were analysed. Additional structures apart from “strawberry pattern”, white scales and superficial keratin were considered atypical. Examples of dermatoscopic atypia are visualized in figure 1. Histologically the severity of AK was classified in three grades as suggested by Röwert-Huber et al.2, In grade I AK, atypical keratinocytes are found in the basal and suprabasal layers of the epidermis. In grade II AK, atypical keratinocytes extend to the lower two-thirds of the epidermis. In grade III AK, atypical keratinocytes extend to more than two thirds of the full thickness of the epidermis. Statistical analyses were performed using IBM SPSS Association between either clinical or dermatoscopic atypia and histological severity was assessed with Mann Whitney U test. The level of significance was set at The study was approved by the Ethical Committee of Riga Stradiņš University.
p=0.025
Figure 2. Association between presence of dermatoscopic atypia and morphologic grade of actinic keratosis
Conclusions
This study shows that often a single clinically and/or dermatoscopically different lesion can be found in a field of actinic keratoses. In addition, dermatoscopically seen structures can aid in identifying morphologically more dysplastic lesions.
References
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1. Grob, J. J. and Bonerandi, J., J. (1998) ‘The “Ugly Duckling” Sign: Identification of the Common Characteristics of Nevi in an Individual as a Basis for Melanoma Screening’, Arch Dermatol., 134, pp. 103–114.
2. Röwert-Huber, J. et al. (2007) ‘Actinic keratosis is an early in situ squamous cell carcinoma: A proposal for reclassification’, British Journal of Dermatology, 156(SUPPL. 3), pp. 8–12. doi: /j x.
Figure 1. Lesions considered dermatoscopically atypical. Presence of hairpin vessels (black arrows), superficial erosions (dashed circle), white homogenous areas (black circle) and glomerular vessels (red arrow) are visualized.