journal article·2024-01-30Open access

Intraoperative PRO Score Assessment of Actinic Keratosis with FCF Fast Green-Enhanced Ex Vivo Confocal Microscopy

Daniela Hartmann, Lisa Buttgereit, Lara Stärr, Elke Christina Sattler, Lars Einar French, Maximilian Deußing

Applied Sciences· Volume 14· Issue 3

Abstract

Actinic keratoses (AKs) represent a common skin cancer in situ associated with chronic sun exposure. Early diagnosis and management of AKs are crucial to prevent their progression to invasive squamous cell carcinoma. Therefore, we investigated AK PRO score assessment using ex vivo confocal laser microscopy (EVCM) coupled with a novel fluorescent dye, FCF Fast Green, to explore its potential for the precise imaging and discrimination of collagen fibers. AK PRO assessment using EVCM demonstrated excellent conformity (95.8%) with histopathologic examination. The additional utilization of FCF Fast Green dye had no impact on AK visualization but showed a high affinity for collagen fibers enabling clear differentiation of collagen alterations between healthy and sun-damaged skin. The enhanced visualization of collagen fiber changes may aid clinicians in accurately identifying AKs and differentiating them from benign skin lesions.
Source: crossref · Quality: baseline

Research context

OpenAlex topics: Nonmelanoma Skin Cancer Studies · Skin Protection and Aging · Cutaneous Melanoma Detection and Management

SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.

Affiliations

Department of Dermatology and Allergy, LMU University Hospital, LMU Munich, 80337 Munich, Germany

Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA

References (40)

Show source-provided references
1. Actinic Keratosis: Current Therapies and Insights into New Treatments
2. Guidelines of care for the management of actinic keratosis10.1016/j.jaad.2021.02.082 ↗
3. Actinic keratoses: Review of clinical, dermoscopic, and therapeutic aspects10.1016/j.abd.2019.10.004 ↗
4. Plewig, G., Ruzicka, T., Kaufmann, R., and Hertl, M. (2018). Braun-Falco’s Dermatologie, Venerologie und Allergologie, Springer.10.1007/978-3-662-49544-5 ↗
5. Dermatopathologic features of cutaneous squamous cell carcinoma and actinic keratosis: Consensus criteria and proposed reporting guidelines10.1016/j.jaad.2022.12.057 ↗
6. Histopathology of incipient intraepidermal squamous cell carcinoma (“actinic keratosis”)10.1067/mjd.2000.103344 ↗
7. The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) consensus statement on the management of vaginal intraepithelial neoplasia10.1136/ijgc-2022-004213 ↗
8. Anal intraepithelial neoplasia: Diagnosis, screening, and treatment
9. Actinic keratosis is an early in situ squamous cell carcinoma: A proposal for reclassification10.1111/j.1365-2133.2007.07860.x ↗
10. Actinic keratosis with atypical basal cells (AK I) is the most common lesion associated with invasive squamous cell carcinoma of the skin10.1111/jdv.12848 ↗
11. Cutaneous squamous cell carcinomas are associated with basal proliferating actinic keratoses10.1111/bjd.16536 ↗
12. Actinic keratoses show variable histological basal growth patterns—A proposed classification adjustment10.1111/jdv.14512 ↗
13. Actinic keratosis: Correlation between clinical and histological classification systems10.1111/jdv.13626 ↗
14. Dermoscopy of facial nonpigmented actinic keratosis10.1111/j.1365-2133.2006.07426.x ↗
15. Cerroni, L., Garbe, C., Metze, D., Kutzner, H., and Kerl, H. (2016). Histopathologie der Haut, Springer.10.1007/978-3-662-45133-5 ↗
16. Vladimirova, G., Ruini, C., Kapp, F., Kendziora, B., Ergün, E.Z., Bağcı, I.S., Krammer, S., Jastaneyah, J., Sattler, E.C., and Flaig, M.J. (2022). Ex vivo confocal laser scanning microscopy: A diagnostic technique for easy real-time evaluation of benign and malignant skin tumours. J. Biophotonics, 15.10.1002/jbio.202100372 ↗
17. Inserting ex vivo fluorescence confocal microscopy perioperatively in Mohs micrographic surgery expedites bedside assessment of excision margins in recurrent basal cell carcinoma10.1159/000353577 ↗
18. In Vivo and Ex Vivo Confocal Microscopy for Dermatologic and Mohs Surgeons10.1016/j.det.2016.05.012 ↗
19. Ex vivo confocal laser scanning microscopy for melanocytic lesions and autoimmune diseases10.1007/s00105-021-04906-1 ↗
20. Identification of ex-vivo confocal laser scanning microscopic features of melanocytic lesions and their histological correlates10.1002/jbio.201500335 ↗
21. Ex vivo confocal laser scanning microscopy with digital staining is able to map characteristic histopathological features and tissue reaction patterns of inflammatory skin diseases10.1111/jdv.17006 ↗
22. Basal cell carcinoma characterization using fusion ex vivo confocal microscopy: A promising change in conventional skin histopathology10.1111/bjd.18239 ↗
23. Shavlokhova, V., Flechtenmacher, C., Sandhu, S., Pilz, M., Vollmer, M., Hoffmann, J., Engel, M., and Freudlsperger, C. (2020). Detection of oral squamous cell carcinoma with ex vivo fluorescence confocal microscopy: Sensitivity and specificity compared to histopathology. J. Biophotonics, 13.10.1002/jbio.202000100 ↗
24. Routine application of ex vivo confocal laser scanning microscopy with digital staining for examination of surgical margins in basal cell carcinomas
25. Clinical applicability of in vivo reflectance confocal microscopy in dermatology
26. Multimodal confocal microscopy for diagnosing nonmelanoma skin cancers10.1002/lsm.20578 ↗
27. Ex vivo confocal microscopy: An emerging technique in dermatology10.5826/dpc.0802a08 ↗
28. Segnani, C., Ippolito, C., Antonioli, L., Pellegrini, C., Blandizzi, C., Dolfi, A., and Bernardini, N. (2015). Histochemical Detection of Collagen Fibers by Sirius Red/Fast Green Is More Sensitive than van Gieson or Sirius Red Alone in Normal and Inflamed Rat Colon. PLoS ONE, 10.10.1371/journal.pone.0144630 ↗
29. A simple micromethod for collagen and total protein determination in formalin-fixed paraffin-embedded sections10.1177/33.8.2410480 ↗
30. High-resolution confocal and light-sheet imaging of collagen 3D network architecture in very large samples10.1016/j.isci.2023.106452 ↗
31. Six steps to reach optimal scanning in ex vivo confocal microscopy10.1016/j.jaad.2021.01.044 ↗
32. A fast and effective option for tissue flattening: Optimizing time and efficacy in ex vivo confocal microscopy10.1016/j.jaad.2019.06.041 ↗
33. Evaluation of two histological classifications for actinic keratoses—PRO classification scored highest inter-rater reliability10.1111/jdv.15580 ↗
34. Evidence- and consensus-based (S3) Guidelines for the Treatment of Actinic Keratosis—International League of Dermatological Societies in cooperation with the European Dermatology Forum—Short version10.1111/jdv.13180 ↗
35. Natural and sun-induced aging of human skin10.1101/cshperspect.a015370 ↗
36. The pathophysiology of photoaging of the skin
37. Alterations in human dermal connective tissue with age and chronic sun damage10.1038/jid.1962.122 ↗
38. Occupational ultraviolet light exposure increases the risk for the development of cutaneous squamous cell carcinoma: A systematic review and meta-analysis10.1111/j.1365-2133.2010.10118.x ↗
39. Detection of basal cell carcinomas in Mohs excisions with fluorescence confocal mosaicing microscopy10.1111/j.1365-2133.2009.09141.x ↗
40. Digital imaging fluorescence microscopy: Spatial heterogeneity of photobleaching rate constants in individual cells10.1083/jcb.100.4.1309 ↗