title: Reflectance confocal microscopy for noninvasive monitoring of therapy and detection of subclinical actinic keratoses.
abstract: BACKGROUND
  Actinic keratoses (AK) represent cutaneous carcinoma in situ and have previously been evaluated by reflectance confocal microscopy (RCM). Treatment of AK with imiquimod (IMIQ) 5% cream has been shown to 'highlight' subclinical lesions.
  
  
  OBJECTIVE
  The aim of this study was to test the applicability of RCM for noninvasive monitoring of actinic field cancerization and detection of subclinical AK.
  
  
  METHODS
  AK and surrounding skin sites with no apparent AK of 11 volunteers were selected for imaging and subsequently classified as 'clinical' and 'subclinical' AK. IMIQ was used 3 times weekly for 4 weeks.
  
  
  RESULTS
  RCM was able to detect morphologic features of AK in both clinical and subclinical AK; features were more pronounced in clinical lesions. The immunomodulatory response induced by IMIQ was visualized by RCM.
  
  
  CONCLUSIONS
  Our findings indicate that RCM allows noninvasive monitoring of treatment response in vivo and permits early detection of subclinical AK, thus substantiating the incentive for therapy.
authors.affiliation: Skin Cancer Center Charité, Department of Dermatology, Charité University Medicine, Berlin, Germany. martina.ulrich @ charite.de
authors.forename: M
authors.initials: M
authors.lastname: Ulrich
authors.forename: D
authors.initials: D
authors.lastname: Krueger-Corcoran
authors.forename: J
authors.initials: J
authors.lastname: Roewert-Huber
authors.forename: W
authors.initials: W
authors.lastname: Sterry
authors.forename: E
authors.initials: E
authors.lastname: Stockfleth
authors.forename: S
authors.initials: S
authors.lastname: Astner
mesh_terms: D000368:Aged; D000634:Aminoquinolines / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002278:Carcinoma in Situ / Q000188:drug therapy* / Q000473:pathology; D016903:Drug Monitoring / Q000379:methods*; D006801:Humans; D000077271:Imiquimod; D055623:Keratosis, Actinic / Q000188:drug therapy* / Q000473:pathology; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000634:Aminoquinolines; D000970:Antineoplastic Agents; D000077271:Imiquimod