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|Non-invasive Diagnose von aktinischen Keratosen mittels Reflektanz konfokaler Lasermikroskopie|
|Main title||Non-invasive Diagnose von aktinischen Keratosen mittels Reflektanz konfokaler Lasermikroskopie|
|Title variations||Non-invasive diagnosis of actinic keratosis with reflectance confocal microscopy|
Place of birth: Kiel
|1. Referee||Prof. Dr. med. Eggert Stockfleth|
|Further Referee(s)||Prof. Dr. med. R.- M. Szeimies
Prof. Dr. med. A. Rübben
|Classification (DDC)||610 Medical sciences; Medicine|
|Summary||Actinic keratosis (AK) are the most common carcinoma in situ of the skin and have shown an increase in incidence during the past decades. UV-exposure represents the most important risk factor and leads to the dysplasia of entire fields of keratinocytes. This has been referred to as actinic field cancerization. In the past years novel non-invasive treatment modalities have been developed for the treatment of field cancerization.
Diagnosis of AK is often made on clinical grounds and biopsy is performed for confirmation. The use of non-invasive treatment modalities has lead to the development of new diagnostic technologies, including reflectance confocal microscopy. In-vivo reflectance confocal micrsocopy (RCM) is a non-invasive imaging technique that allows the evaluation of cellular structures of the skin in real-time. RCM has previously been applied for a variety of inflammatory and neoplastic skin diseases, but the evaluation of AK has only been the subject of preliminary studies. A total of 46 AK and 10 control sites were included in this study. We performed clinical examination of all test sites and subsequently performed RCM evaluation, followed by biopsy and subsequent histologic evaluation. Sensitivity and specificity analysis, kappa-analysis and Spearman`s correlation was performed in order to define diagnostic relevant criteria for AK.
In a second analysis we evaluated disseminated superficial actinic porokeratosis (DSAP) as a differential diagnosis of AK.
By RCM sensitivity and specificity ranged between 80 and 98.6% for selected parameters. Pleamorphism of cells and nuclei and architectural disarray were found to be the most predictive parameter for AK. Concordance of 2 independent observers for the different criteria ranged between 87% und 98.2%.
RCM represents a promising technique for the non-invasive evaluation of actinic keratosis. Further investigations will show the applicability of RCM for subclinical lesions and therapeutic monitoring of AK.
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|FU Department||Department of Medicine - Charité - University Medicine Berlin|
|Year of publication||2009|
|Document type||Doctoral thesis|
|Date of defense||2009-03-27|
|Created at||2009-02-25 : 08:34:48|
|Last changed||2010-02-19 : 09:55:15|