title: Clinical applicability of in vivo reflectance confocal microscopy for the diagnosis of actinic keratoses.
abstract: BACKGROUND
  In vivo reflectance confocal microscopy (RCM) has been used for evaluation of the morphologic features of nonmelanoma skin cancer. The application of RCM for diagnosis of basal cell carcinoma has been reported; however, the evaluation of actinic keratoses (AKs) has only been the subject of preliminary studies.
  
  
  OBJECTIVE
  The goal of this study was to evaluate the applicability of RCM in the diagnosis of AK in correlation with routine histology.
  
  
  METHODS
  Forty-four Caucasians with a minimum of one AK participated in this study. Evaluation consisted of clinical examination, RCM, and routine histology, including a total of 46 AKs in the final analysis. Ten normal skin sites served as controls. RCM features of AK included parakeratosis, architectural disarray, and keratinocyte pleomorphism. Following blinded evaluations, sensitivity/specificity, kappa analysis, and Spearman's correlation were performed on all parameters.
  
  
  RESULTS
  Sensitivity/specificity values of RCM features ranged from 80% to 98.6%. The presence of architectural disarray and cellular pleomorphism appeared to be the best predictor of AK.
  
  
  CONCLUSIONS
  In summary, RCM may be a promising technology for the noninvasive detection of AK and as adjunct tool to clinical diagnosis and monitoring. However, the preliminary nature of this study warrants further investigations.
authors.affiliation: Department of Dermatology, Charité University Medicine, Berlin, Germany. martina.ulrich@charite.de
authors.forename: Martina
authors.initials: M
authors.lastname: Ulrich
authors.forename: Adrienne
authors.initials: A
authors.lastname: Maltusch
authors.forename: Francisca
authors.initials: F
authors.lastname: Rius-Diaz
authors.forename: Joachim
authors.initials: J
authors.lastname: Röwert-Huber
authors.forename: Salvador
authors.initials: S
authors.lastname: González
authors.forename: Wolfram
authors.initials: W
authors.lastname: Sterry
authors.forename: Eggert
authors.initials: E
authors.lastname: Stockfleth
authors.forename: Susanne
authors.initials: S
authors.lastname: Astner
mesh_terms: D000368:Aged; D046169:Dermoscopy; D004817:Epidermis / Q000473:pathology*; D006801:Humans; D007642:Keratosis / Q000473:pathology*; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric