The clinical value of reflectance confocal microscopy in monitoring treatment of actinic keratosis: A systematic review

Abstract

Background

Actinic keratosis (AK) is a precancerous skin lesion that can progress to squamous cell carcinoma (SCC). Early diagnosis and effective treatment are crucial, but current treatment evaluation methods lack consistency. Reflectance confocal microscopy (RCM) has emerged as a promising non-invasive tool for monitoring treatment outcomes in AK, but the absence of standardized evaluation protocols limits its clinical applicability.

Objective

This study aims to establish standardized RCM imaging features for evaluating treatment responses in AK, thereby enhancing the consistency and clinical utility of RCM in treatment monitoring.

Methods

A systematic review was conducted following the PRISMA 2020 guidelines. Studies that evaluated the treatment of AK using RCM were included. A comprehensive literature search was performed across MEDLINE, Embase, and the Cochrane Library up to October 2024. Data on study design, treatment modalities, RCM imaging features, and scoring systems were extracted. A meta-analysis was not performed due to heterogeneity in study designs and outcome measures.

Conclusion

This review identifies key RCM imaging features of AK, including keratinocyte atypia and architectural disarray, and highlights the lack of a standardized scoring system for evaluating treatment outcomes. The findings underscore the need for a universally accepted protocol to improve the consistency and reliability of RCM in clinical practice. Standardization of RCM evaluation will enhance its utility in both clinical monitoring and future research on AK treatment.