Fluorescence diagnosis in keratinocytic intraepidermal neoplasias

• Published in: Journal of the American Academy of Dermatology Vol. 57; no. 5; pp. 824 - 831
• Main Authors: Smits, Tim, MD, Kleinpenning, Marloes M., MD, Blokx, Willeke A.M., MD, PhD, van de Kerkhof, Peter C.M., MD, PhD, van Erp, Piet E.J., PhD, Gerritsen, Marie-Jeanne P., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.11.2007; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Aminolevulinic Acid; Biological and medical sciences; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - metabolism; Carcinoma, Squamous Cell - pathology; Cell Proliferation; Dermatology; Diagnosis, Computer-Assisted; Diagnosis, Differential; Epidermis - pathology; Female; Fluorescence; Humans; Immunohistochemistry; Keratinocytes - pathology; Ki-67 Antigen - analysis; Male; Medical sciences; Middle Aged; Neoplasm Staging; Photosensitizing Agents; Protoporphyrins; Skin Neoplasms - diagnosis; Skin Neoplasms - metabolism; Skin Neoplasms - pathology; charged coupled device; PDT; BD; CCD; photodynamic therapy; tagged image file format; Bowen's disease; PpIX; AK; actinic keratosis; FDAP; keratinocytic intraepidermal neoplasia; SC; KIN; stratum corneum; SCC; TIFF; fluorescence diagnosis with aminolevulinic acid–induced porphyrins; protoporphyrin-IX; ALA; aminolevulinic acid; squamous cell carcinoma; Fluorescence; Tumor; Diagnosis; Dermatology
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2007.06.031

Background As different tissue types have distinct capabilities to accumulate protoporphyrin-IX, fluorescence diagnosis with aminolevulinic acid–induced porphyrin (FDAP) could be used to discriminate between different tissue types. Objective Protoporphyrin-IX accumulation and proliferation were studied in cutaneous squamous (pre)malignancies to see whether FDAP could be used to discriminate between different stages of keratinocytic intraepidermal neoplasia or proliferative status. Methods FDAP was performed in 14 patients (86 lesions) and biopsy specimens were taken, on which (immuno)histochemistry was performed for histopathologic classification and assessment of Ki67-antigen expression. Stratum corneum thickness was also measured. Results The fluorescence ratio (lesional:nonlesional skin) showed neither significant differences between the different keratinocytic intraepidermal neoplasia stages, nor between different levels of Ki67-antigen expression. Macroscopic fluorescence intensity and stratum corneum thickness were negatively correlated. Limitations Relatively few malignancies were biopsied. Conclusions With FDAP we were not able to discriminate between keratinocytic intraepidermal neoplasia lesions or proliferative activity. However, hyperkeratosis appeared to be an important determinant in variations in macroscopic fluorescence intensity.