Diagnostic Accuracy of Dermoscopy of Actinic Keratosis: A Systematic Review

Abstract

Introduction: Dermoscopy is a tool that aids clinicians in the diagnosis of actinic keratosis; however, few diagnostic accuracy studies have determined its sensitivity and specificity for this diagnosis.
 Objective: Determine the diagnostic accuracy of dermoscopy on actinic keratosis.
 Methods: A systematic review was conducted on EMBASE, PubMed, Scopus and the Cochrane Central Registry of Controlled Trials from inception to August 2019.
 Results: We screened 485 titles and abstracts. Two studies comprising 219 actinic keratoses were eligible for qualitative analysis. The number and heterogeneity of included studies limited a quantitative analysis.
 Conclusions: Studies that focus specifically on the diagnostic accuracy of dermoscopy for actinic keratosis are lacking.

Line‐field confocal optical coherence tomography for actinic keratosis and squamous cell carcinoma: a descriptive study

“…Additional noninvasive tools such as reflectance confocal microscopy (RCM), conventional optical coherence tomography (OCT) and high‐definition (HD)‐OCT provide information that is closer to that obtained by histological examination, and have been investigated in terms of diagnostic performance for both clinical and subclinical keratinocyte skin tumours 4,12 . Dedicated Cochrane Reviews found insufficient evidence for the use of RCM or OCT for the diagnosis of SCC 17–19 . OCT can show the destruction of the epidermal/dermal layering in keratinocyte skin tumours but does not have sufficient resolution to identify single keratinocytes and to clearly identify keratinocyte tumour proliferation 20 .…”

“… 4 , 12 Dedicated Cochrane Reviews found insufficient evidence for the use of RCM or OCT for the diagnosis of SCC. 17 , 18 , 19 OCT can show the destruction of the epidermal/dermal layering in keratinocyte skin tumours but does not have sufficient resolution to identify single keratinocytes and to clearly identify keratinocyte tumour proliferation. 20 Although RCM has a higher lateral resolution than conventional OCT (1 μm vs. 7.5 μm) and can detect cellular changes, 16 , 21 it has a lower penetration (˜200 μm vs. 1–2 mm) that can prevent visualization of the dermoepidermal junction (DEJ) in hyperkeratotic lesions, and RCM only provides horizontal skin sections, in which it is more difficult to define tumour invasiveness and to discriminate AK from SCC than with conventional OCT. 12 , 20 HD‐OCT seemed to overcome the problems of both the previous techniques by providing images with cellular resolution (isotropic resolution 3 μm), good penetration (˜570 μm) and vertical sections.…”

Line‐field confocal optical coherence tomography for the in vivo real‐time diagnosis of different stages of keratinocyte skin cancer: a preliminary study

“…The diagnosis of KC is based on clinical and dermoscopical examination, eventually followed by a biopsy 1 . Dermoscopy has a good reported sensitivity and specificity in diagnosing and grading KC, although significantly higher for AKs (51.2%–98%; 95%) rather than SCCs (55%–79%; 84%–87%) and mainly calculated in the context of retrospective studies, so that further prospective studies are needed 3–11 . Non‐invasive diagnostic methods such as reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) have been widely used in the diagnosis of AKs 12–16 , while few articles analysed the sensitivity and specificity of such tools for invasive SCCs 14,17 .…”

“…1 Dermoscopy has a good reported sensitivity and specificity in diagnosing and grading KC, although significantly higher for AKs (51.2%-98%; 95%) rather than SCCs (55%-79%; 84%-87%) and mainly calculated in the context of retrospective studies, so that further prospective studies are needed. [3][4][5][6][7][8][9][10][11] Non-invasive diagnostic methods such as reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) have been widely used in the diagnosis of AKs [12][13][14][15][16] , while few articles analysed the sensitivity and specificity of such tools for invasive SCCs. 14,17 RCM, which displays horizontal sections, allows a detection of characteristic AK patterns with high resolution 10,18 ; however, its low penetration depth (up to 200-250 µm) can be a limit in evaluating the DEJ and the infiltration of the dermis in thick lesions.…”

Dermatoscopy of Facial Non-Pigmented Actinic Keratosis and Intraepidermal Carcinoma

“…In comparison, dermatoscopy improves the diagnostic accuracy of both AK and SCC. A recent systematic review and study by Huerta-Brogeras et al showed sensitivity up to 98.7% and specificity up to 95% if AK is diagnosed with dermatoscopy [15,16].…”