Eggert Stockfleth (editor) - Managing Skin Cancer

( a ) Corresponds to clinical image of 67-year-old male, with a long standing history of sun-exposure. Clinical evaluation reveals numerous and confluent hyperkeratotic papules and plaques on sun-exposed areas of the balding scalp, consistent with actinic field cancerization. Normal skin is difficult to distinguish from clinically affected skin sites. Histology confirmed the diagnosis of actinic keratoses (AK). ( be ) Correspond to representative RCM images of AK. ( b ) RCM image obtained at the level of the stratum corneum with noted scaling and demarcation of individual corneocytes, seen as detached bright, polygonal structures ( white arrows ). ( c ) RCM image illustrating parakeratosis, identified by the dark nucleus placed centrally within the bright appearing corneocytes. The irregularities of the epidermal architecture are seen as dark hollow between bright rims of keratinocytes. ( d ) RCM image illustrating keratino-cyte pleomorphism, with atypical nuclei seen as dark round to oval, to polygonal structures ( white arrows ) of variable size and orientation. ( e ) RCM image obtained at the level of the mid-to-upper dermal layer illustrating solar elastosis. Irregular bundles of bright appearance and somewhat haphazard distribution correspond to irregular dermal elastic fibers. (RCM images obtained by VivaScope 1500, image dimensions 500500 m)