Field cancerization and monitoring of treatment Book Section
| Authors: | Ulrich, M.; Pasquali, P.; Zalaudek, I.; Moscarella, E.; González, S. |
| Editor: | González, S. |
| Article/Chapter Title: | Field cancerization and monitoring of treatment |
| Abstract: | Actinic keratoses frequently occur as multiple lesions in chronically sun-damaged areas, a phenomenon that has been described by the term actinic field cancerization. Initially being introduced for similar findings in mucosa,1 this concept has early been adapted for squamous neoplasia of the skin.2 Within these areas of field cancerization, different stages of the cutaneous squamous neoplasia may occur, which include actinic keratoses, squamous cell carcinoma (SCC) in situ/Bowen disease, and invasive SCC. Stepwise progression from actinic keratosis (AK) to invasive SCC (iSCC) of the skin occurs in the classic pathway described for mucosa but also by direct invasion from proliferating basaloid atypical keratinocytes (AK I)-“differentiated pathway”-as described by Fernández-Figueras.3 Very early stages of squamous neoplasia can be present inside these fields. These lesions are clinically invisible but display proliferation of atypical keratinocytes and have therefore been referred to as subclinical lesions or AKs (sc-AK). During studies with the immune response modifier imiquimod, which was applied not to single AK, but to diseased areas of 25 cm2, an increase of lesions after treatment and their clearance have been shown.4 However, the detection of these subclinical lesions remained difficult until the introduction of reflectance confocal microscopy (RCM) in dermatology. RCM allows detection of subclinical AK by in vivo visualization of cellular atypia in the epidermis.5 Multiple lesions within the actinically damaged field can be imaged without tissue alteration (biopsy), and RCM also allows monitoring of these lesions during several time points, e.g., for monitoring of pharmacodynamic effects or treatment response or procedural therapies (cryosurgery, photodynamic theray [PDT]). The further development of a handheld device has facilitated the imaging of larger areas, and the first studies have been performed using this emerging technology.6-10 Clinically, actinic field cancerization is characterized by the presence of multiple AK within areas of chronic sun damage. The sizes of these fields may vary as does their clinical appearance that may display solar lentigos, atrophy, mild erythema, or wrinkles according to location and skin type. Although clinical and dermoscopy features of AK and SCC are well known (please refer to Chapter 37 for more details), sc-AKs cannot be detected by visual inspection. However, RCM enables the visualization of keratinocyte atypia within cancerized fields and is applicable for monitoring treatment response of AK as well as sc-AK (Figure 46.1). © 2017 by Taylor and Francis Group, LLC. |
| Book Title: | Reflectance Confocal Microscopy of Cutaneous Tumors. 2nd ed |
| ISBN: | 9781498757614 |
| Publisher: | CRC Press |
| Publication Place: | Boca Raton, FL |
| Date Published: | 2017-01-01 |
| Start Page: | 490 |
| End Page: | 495 |
| Language: | English |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Book Chapter: 46 -- Export Date: 1 November 2018 -- Source: Scopus |
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203Rodriguez
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