Actinic Keratosis (AK)

VivoSight imaging of AK and sub-clinical AK

VivoSight enables assessment of AK lesions providing the following benefits:

  • VivoSight images show markers specific to AK
  • OCT pre-scanning shows lesion details which can aid in the treatment selection
  • Visualization of sub-clinical lesions
  • Understand local and field spread of overall AK
  • Monitor treated site through follow-up VivoSight scanning
  • Opportunity to offer premium maintenance treatments (laser/PDT) and control recurrences through periodic VivoSight follow-ups
Typical presentation of hyperkeratotic AK lesions against a backdrop of large area field cancerization

VivoSight Presentations of AK

Actinic keratosis presents with atypical thickening of the epidermis. Thickening of the epidermis at the lesion edges is usually focused to the stratum corneum layer

Thicker, hyperkeratotic AK: multi-layered, thickened epidermis. White arrows: base of lesion
Thinner AK: multi-layered, thickened epidermis, DEJ visible
Sub-clinical AK

Treatment Examples

Case 1: Topical treatment of subclinical AK with ingenol mebutate gel

Subclincal AK is characterized in OCT by hyperkeratosis (oblique arrow), with broadened epidermis and irregular layering, with remnants of the dermoepidermal junction (straight arrow) that is mainly lost (asterisks)
After therapy, OCT shows a relatively normal epidermis with a restoration of the dermo-epidermal junction (arrows) and some dilated vessels (stars). Images courtesy of Ruini [3]

Case 2: Topical treatment with Imiquimod 3.75% cream.

  • Treatment of moderate AK lesion with imiquimod 3.75% cream. Note restored epidermis and dermo-epidermal junction after therapy regimen . Images courtesy of Reinhold [8]

Case 3: Fractional laser-assisted treatment of AK. Periodic follow-up with VivoSight.

  • Fractional laser alone treatment, and laser-assisted PDT treatment of AK also leads to a noticeable cosmetic effect [7]
  • Periodically (annually) scheduled follow-up visits can use VivoSight to check for AK recurrences or subclinical lesions. Opportunity to offer subsequent prophylactic laser resurfacing (Sciton Halo [6]) as annual, premium maintenance treatment.
Hybrid Fractional Ablative Laser Resurfacing of Actinic Keratoses. Before & after single treatment. Images courtesy of Ortiz [6]

References:

1. Haedersdal M, Erlendsson AM, Paasch U, Anderson RR. Translational medicine in the field of ablative fractional laser assisted drug delivery: a critical review from basics to current clinical status. J Am Acad Dermatol 2016;74(5): 981–1004.

2. Steeb T, Schlager JG, Kohl C, Ruzicka T, Heppt MV, Berking C; Laser-assisted photodynamic therapy for actinic keratosis: A systematic review and meta-analysis. J Am Acad Dermatol. 2018 Sep 26.

3. Ruini C, Hartmann D, Bastian M, et al. Non-invasive monitoring of subclinical and clinical actinic keratosis of face and scalp under topical treatment with ingenol mebutate gel 150 mcg/g by means of reflectance confocal microscopy and optical coherence tomography: New perspectives and comparison of diagnostic techniques. J. Biophotonics. 2019;e201800391. https://doi.org/10.1002/ jbio.201800391

4. Markowitz O, Wang K, Levine A, Schwartz M, Minhas S, Feldman E, Siegel DM. Noninvasive Long-term Monitoring of Actinic Keratosis and Field Cancerization Following Treatment with Ingenol Mebutate Gel 0.015. J Clin Aesthet Dermatol. 2017 Oct;10(10):28-33.

5. Schuh S, Kaestle R, Sattler EC, Welzel J. Optical coherence tomography of actinic keratoses and basal cell carcinomas – differentiation by quantification of signal intensity and layer thickness. J Eur Acad Dermatol Venereol. 2016 Aug;30(8):1321-6

6. Ortiz A, Brown M; Hybrid Fractional Ablative and Nonablative Laser Resurfacing of Actinic Keratoses; Dermatol Surg 2018;0:1–4

7. Wenande E et. al., Efficacy and safety of daylight photodynamic therapy after tailored pretreatment with ablative fractional laser or microdermabrasion: a randomized, side-by-side, single-blind trial in patients with actinic keratosis and large-area field cancerization; Br J Dermatol. 2019 Apr;180(4):756-764

8. Onkoderm04_Sept2012.pdf. Interview mit Prof. Thomas Dirschka, Düsseldorf, und Prof. Uwe Reinhold, Bonn

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