Background: Actinic keratosis (AK) is a common UV-induced intraepidermal neoplasm and a precursor to cutaneous squamous cell carcinoma (cSCC). Accurate, non-invasive assessment of AK severity is crucial for early intervention and risk stratification. Objective: To evaluate the relationship between clinical severity of AK, as defined by the Olsen grading scale, and predefined dermoscopic and reflectance confocal microscopy (RCM) features.Methods: This cross-sectional study enrolled 50 patients with clinically diagnosed AK at a tertiary dermatology center between April 2024 and July 2025. Each lesion was assessed clinically using the Olsen scale (grades 1–3), dermoscopically (five features scored 0–3; total score 0–15), and via RCM (five RCM parameters scored 0–3; total score 0–15). Statistical correlations between clinical grade and imaging features were analyzed using Pearson’s χ2test with effect size metrics.Results: Diffuse erythema (p< 0.001), micro-erosions (p= 0.002), strawberry pattern (p= 0.038), and scales (p= 0.012) correlated significantly with Olsen grade, whereas vessels (p= 0.566) did not. All five RCM parameters showed strong associations with clinical severity. Composite dermoscopic and RCM scores correlated with Olsen grade (bothp< 0.001). Abnormal honeycomb pattern, parakeratosis, inflammation, and solar elastosis were the best RCM predictors of high dermoscopic severity (allp< 0.001); conversely, erosions, erythema, and scales were the strongest dermoscopic predictors of high RCM severity (allp< 0.001).Conclusions: This study demonstrates strong, statistically significant associations between clinical, dermoscopic, and confocal features of AK. This supports the integration of multimodal scoring into unified AK severity frameworks.
背景：光化性角化病（AK）是一种常见的紫外线诱发的表皮内肿瘤，是皮肤鳞状细胞癌（cSCC）的癌前病变。对AK严重程度进行准确、无创的评估对于早期干预和风险分层至关重要。目的：评估依据Olsen分级标准定义的AK临床严重程度与预设的皮肤镜及反射式共聚焦显微镜（RCM）特征之间的关系。方法：这项横断面研究于2024年4月至2025年7月期间，在一家三级皮肤科中心招募了50名临床诊断为AK的患者。每个皮损均使用Olsen分级（1-3级）进行临床评估，同时进行皮肤镜评估（五个特征，评分0-3分；总分0-15分）和RCM评估（五个RCM参数，评分0-3分；总分0-15分）。采用Pearson χ²检验结合效应量指标分析临床分级与影像学特征之间的统计学相关性。结果：弥漫性红斑（p < 0.001）、微糜烂（p = 0.002）、草莓样模式（p = 0.038）和鳞屑（p = 0.012）与Olsen分级显著相关，而血管（p = 0.566）则无显著相关。所有五个RCM参数均与临床严重程度呈强相关。皮肤镜综合评分和RCM综合评分均与Olsen分级相关（均p < 0.001）。异常的蜂窝状模式、角化不全、炎症和日光性弹力纤维变性是预测高皮肤镜严重程度的最佳RCM指标（均p < 0.001）；反之，糜烂、红斑和鳞屑是预测高RCM严重程度最强的皮肤镜指标（均p < 0.001）。结论：本研究证实了AK的临床、皮肤镜及共聚焦特征之间存在强且具有统计学显著性的关联。这支持将多模态评分整合到统一的AK严重程度评估框架中。
肿瘤(癌症)患者之家