Dermatologie (Heidelberg, Germany)最新文献

Background: The number of patients with keratinocyte tumors is steadily increasing. In addition, personnel and procedural costs for surgical treatment are also rising.

Objectives: How suitable are modern, noninvasive dermatological imaging devices for improving the efficiency of tumor diagnostics and therapy in keratinocyte skin cancer, thereby enhancing treatment outcomes?

Materials and methods: Description of the process using a patient pathway and case studies, with discussion of existing literature and future perspectives.

Results and discussion: Modern noninvasive imaging techniques such as line-field confocal optical coherence tomography (LC-OCT) offer promising approaches in the surgical treatment of keratinocyte skin cancer, enabling high-resolution real-time tumor diagnostics. Early studies show that LC-OCT can be used both for early diagnosis without biopsy and for preoperative margin delineation of basal cell carcinomas. These techniques allow for efficiency-enhancing concepts in modern tumor therapy. However, clinical data on the practicability of these methods are currently lacking, highlighting the urgent need for validated studies for critical evaluation.

Conclusion: Noninvasive imaging can increase the efficiency of diagnosis and treatment of keratinocyte tumors through early and rapid diagnosis as well as artificial intelligence-assisted surgical planning.

Poikilodermatous mycosis fungoides is a rare variant of mycosis fungoides (MF), characterized by a distinctive triad of epidermal atrophy, reticulated coalescing erythematous papules or plaques, and telangiectasia. Histologically, a band-like infiltrate of epidermotropic atypical lymphocytes can be observed. Diagnostic differentiation from other poikilodermatous dermatoses is challenging due to overlapping clinical and histopathological features. We present the case of a 66-year-old woman with slowly progressive cutaneous lesions on the trunk over a period of 6 years, whose definitive diagnosis was only established through serial skin biopsies and immunohistochemical analyses. This case underscores the diagnostic challenges and highlights the importance of close clinicopathological correlation.

Background: The diagnosis of actinic keratosis (AK), basal cell carcinoma (BCC), and psoriasis may present a challenge in everyday dermatological practice. Clinical and dermoscopic assessments often reach their limits, especially in ambiguous or anatomically difficult-to-access lesions. Biopsies are often impractical, and objective tools for treatment monitoring are lacking.

Objective: To investigate the potential of line-field confocal optical coherence tomography (LC-OCT) combined with artificial intelligence (AI) for noninvasive diagnosis, differentiation, and longitudinal monitoring.

Materials and methods: Analysis and evaluation of LC-OCT imaging data from various studies. Application of AI-based algorithms for the detection of vascular patterns, epidermal changes, and BCC identification using heatmap-supported decision tools.

Results and discussion: The LC-OCT enables high-resolution, real-time visualization of dermoepidermal structures as well as vascular architecture. In combination with AI, objective parameters such as PRO score, atypia, and vascular morphology can be quantified and monitored over time. AI-assisted diagnostics significantly improve diagnostic accuracy-especially in BCC and among less experienced users. However, implementation requires clear guidelines, standardization, and well-defined legal and ethical frameworks.

Conclusion: The LC-OCT combined with AI is a promising tool for more precise, standardized, and personalized dermatological diagnostics. Particularly in AK, BCC, and psoriasis, it has the potential to enhance care, reduce the need for invasive procedures, and provide novel insights into tumor and inflammation biology.

Background: Keratinocyte skin cancers (KC), including basal cell carcinoma (BCC) and the spectrum of squamous cell carcinoma (SCC), represent the most common malignancies worldwide. Accurate diagnosis and margin assessment are critical for optimal treatment but remain challenging when relying solely on clinical and dermoscopic evaluation. Reflectance confocal microscopy (RCM) offers high-resolution, noninvasive imaging of skin architecture at near-histological levels, potentially improving diagnostic precision and reducing the need for (re)biopsies.

Objective: To evaluate the current diagnostic criteria, diagnostic utility, advantages, and limitations of confocal microscopy in the assessment of nonmelanoma skin cancer (NMSC).

Methods: A narrative review of recent literature and current guidelines was conducted, focusing on RCM for the detection, characterization, and monitoring of BCC and KC. Key diagnostic criteria, imaging protocols, and clinical applications were analyzed, including preoperative mapping, differentiation from benign lesions, and follow-up after treatment.

Results: RCM provides real-time visualization of tumor architecture, cellular morphology, and vascular patterns, facilitating the identification of hallmark features such as basaloid tumor islands in BCC and keratinocyte atypia in SCC. Studies report improved diagnostic accuracy and reduced rates of unnecessary excisions. Limitations include restricted imaging depth and the requirement for operator expertise.

Conclusion: RCM represents a powerful adjunct to conventional diagnostic methods for NMSC. Its ability to deliver high-resolution, noninvasive imaging enhances diagnostic confidence, supports surgical planning, and aids in treatment monitoring, ultimately improving patient care. Combining multiple noninvasive techniques with proper training is key to enhancing this approach and promoting its routine clinical use.

Primary cutaneous B‑cell lymphomas (PCBCL) belong to the group of extranodal non-Hodgkin lymphomas and by definition only manifest on the skin at the time of diagnosis. These lymphomas can be broadly classified into indolent and aggressive subtypes. Indolent PCBCLs include primary cutaneous marginal zone lymphoma, primary cutaneous follicular B‑cell lymphoma and Epstein-Barr virus-positive mucocutaneous ulcer, which present solitary or multifocal lesions and are associated with a favorable prognosis. Treatment usually involves excision or radiotherapy, although a watch-and-wait concept can also be discussed. Conversely, aggressive PCBCLs, such as primary cutaneous diffuse large B‑cell lymphoma, leg type, and primary cutaneous intravascular large B‑cell lymphoma, carry a high risk of systemic dissemination. Consequently, they require systemic treatment. The standard first-line therapy is typically the R‑CHOP regimen, which may be supplemented with radiotherapy.

Reflectance confocal microscopy (RCM) is a noninvasive imaging technique offering high lateral resolution and is increasingly used in dermatology for differentiating benign from malignant melanocytic skin lesions such as nevi, melanoma, and lentigo maligna. By directing focused laser light into the skin and capturing reflected signals through a confocal aperture, horizontal optical sections of the epidermis and upper dermis can be generated with a resolution of 1-3 µm. Hallmarks of malignancy-such as pagetoid cells, nonedged papillae, and irregular nests-can be detected in vivo. The penetration depth of the technique is limited to approximately 250-300 µm. One of the key strengths of RCM lies in its ability to delineate tumor margins in lentigo maligna prior to surgical or laser-based therapy. In addition to reflectance imaging, fluorescence-based visualization is possible following topical or intradermal administration of contrast agents. Recent advances integrate artificial intelligence (AI) to assist in the automated analysis of RCM images. Early AI-based systems, such as MED-Net, have demonstrated promising sensitivity and specificity for identifying melanocytic structures. Overall, RCM-especially when combined with validated AI algorithms-represents a valuable extension of diagnostic capabilities in modern dermatologic oncology.