Photodynamic therapy (PDT) with methyl-aminolevulinate (MAL) is an\napproved non-invasive treatment option for actinic keratoses (AKs). In vivo reflectance\nconfocal microscopy (RCM) is a non-invasive tool for real-time imaging of epidermis and\nsuperficial dermis in vivo that has been previously reported to facilitate the in vivo\nevaluation of skin lesions, including AKs. The aim of this study was to investigate the use\nof in vivo RCM in evaluating AKs response to MAL-PDT. For this reason a total of\n10 biopsy-proven AKs were treated by MAL-PDT, according to standard PDT protocol for\nAKs. RCM investigation was performed before and after PDT and RCM-guided punch\nbiopsies was taken at 3 months in all patients for histopathologic examination. At 3 months\nfollow-up, complete clinical response was observed by clinical examination in 9 out of\n10 lesions and a partial clinical response in 1 lesion. In vivo RCM detected two residual\nAKs in subclinical form, missed by clinical examination. Histological analysis confirmed\nthese results. In vivo RCM may be a new alternative tool for the non-invasive diagnosis of\nAKs and evaluation of AKs response to non-invasive treatments, as MAL-PDT, improving\nthe ability of dermatologists to diagnose AKs even in subclinical stage.
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