Monitoring treatment of field cancerisation with 3% diclofenac sodium 2.5% hyaluronic acid by reflectance confocal microscopy: a histologic correlation.
Visual inspection may fail to accurately evaluate field cancerisation (subclinical actinic keratoses [AKs]). We aimed to describe field cancerisation by confocal reflectance microscopy and changes induced by the application of 3% diclofenac sodium gel in 2.5% hyaluronic acid. Fourteen male patients, > 50 years old, with AKs on the bald scalp were included. Clinical examination, confocal microscopy and histological study of clinically visible lesions and "normal appearing" adjacent skin before and after treatment was completed. Reflectance confocal microscopy showed a decrease in scaling (p = 0.001) and atypia of the honeycomb pattern (p = 0.001) at 2 weeks of treatment. Changes in parakeratosis, inflammation and dermal collagen remodelling were also observed. Histology correlated with confocal features in AK and subclinical AK. Reflectance confocal microscopy was useful in the evaluation of field cancerisation and monitoring of treatment response. A rapid improvement in epidermal atypia was observed.
Melanoma Unit, Dermatology Department, Hospital Clinic, ES-08036 Barcelona,, Spain. jmalvehy@gmail.com.
Josep
J
Malvehy
Rodrigo
R
Roldán-Marín
Pablo
P
Iglesias-García
Alba
A
Díaz
Susana
S
Puig
D000279:Administration, Cutaneous; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D001706:Biopsy; D004008:Diclofenac / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D055623:Keratosis, Actinic / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D008857:Microscopy, Interference / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012535:Scalp / Q000187:drug effects* / Q000473:pathology; D012536:Scalp Dermatoses / Q000188:drug therapy* / Q000473:pathology; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D006820:Hyaluronic Acid