Dermoscopy as a Predictor of Photodynamic Therapy Outcomes in Actinic Keratoses and Bowen’s Disease: Prospective Study in Solid Organ Transplant Patients
Keywords:
actinic keratosis, Bowen's disease, Photodynamic therapy (PDT), Cutaneous Squamous Cell Carcinoma, immunocompromised, Methyl aminolevulinate (MAL)Abstract
Introduction: Solid organ transplant recipients (SOTRs) have a significantly higher risk of developing cutaneous squamous cell carcinoma. Identifying predictive markers for response to non-surgical treatments such as photodynamic therapy (PDT) may help optimize management strategies.
Objectives: To evaluate the association
between dermatoscopic features in actinic keratoses (AK) and Bowen’s disease (BD) and response to PDT in SOTRs.
Methods: A prospective observational study was conducted, including 35 SOTRs with clinically and histologically confirmed AK or BD treated with methyl aminolevulinate-PDT. Thirteen dermatoscopic features were analyzed to assess their correlation with treatment response.
Results: Response rates were 62.5% for AK and 89.47% for BD. Among the dermatoscopic features evaluated, white structureless areas in AK and rosettes in BD were significantly associated with resistance to PDT.
Conclusions: Dermoscopy may serve as a valuable tool to predict PDT response in SOTRs with AK and BD, potentially improving patient selection and treatment outcomes.
References
Berg D, Otley CC. Skin cancer in organ transplant recipients: epidemiology, pathogenesis, and management. J Am Acad Dermatol. 2002; 47(1): 1–20. DOI:10.1067/mjd.2002.125579. PMID: 12077575
Basset-Seguin N, Baumann Conzett K, Gerritsen MJP, et al. Photodynamic therapy for actinic keratosis in organ transplant patients. J Eur Acad Dermatol Venereol. 2013; 27: 57–66. DOI: 10.1111/j.1468-3083.2011.04356.x PMID: 22151793
Morelló Vicente A, Oteiza Rius I, Aguado Gil L. Actinic keratosis in solid organ transplant recipients: a medical literature review. Actas Dermosifiliogr. 2024; 115(4): 368–373. DOI: 10.1016/j.ad.2023.10.021. PMID: 37925069
Álvarez-Salafranca M, Zaballos P. Dermoscopy of squamous cell carcinoma: from actinic keratosis to invasive forms. Actas Dermosifiliogr. 2024; 115: 270–273. DOI: 10.1016/j.ad.2024.03.037. PMID: 39102978
Lee JH, Won CY, Kim GM, Kim SY. Dermoscopic features of actinic keratosis and follow up with dermoscopy: a pilot study. J Dermatol. 2014; 41(6): 487–493. DOI: 10.1111/1346-8138.12282. PMID: 25032251
Wang T, Han Q, Hu W, Ren H. Efficacy evaluation and dermoscopy predictors of photodynamic therapy with different pretreatments in the treatment of actinic keratosis. J Dermatolog Treat. 2022; 33(6): 2853–2857. DOI: 10.1080/09546634.2022.2089325. PMID: 35694912
Navarro-Bielsa A, Cerro-Muñoz P, Almenara-Blasco M, Gracia-Cazaña T, Gilaberte Y. Dermoscopic structures predictive of response to photodynamic therapy in basal cell carcinoma. Acta Derm Venereol. 2023; 103: adv00892. DOI: 10.2340/actadv.v103.4838. PMID: 36939536
Gilaberte Y, Serra-Guillén C, de las Heras ME, et al. Photodynamic therapy in dermatology. Actas Dermosifiliogr. 2006; 97(2): 83–102. DOI: 10.1016/s0001-7310(06)73359-2. PMID: 16595110
Gilaberte Y, Aguilar M, Almagro M, et al. Spanish-Portuguese consensus statement on use of daylight-mediated photodynamic therapy with methyl aminolevulinate in the treatment of actinic keratosis. Actas Dermosifiliogr. 2015; 106(8): 623–631. DOI: 10.1016/j.ad.2015.06.001. PMID: 26115793
Bernal Masferrer L, Gracia Cazaña T, Bernad Alonso I, et al. Topical immunotherapy for actinic keratosis and field cancerization. Cancers (Basel). 2024; 16(6): 1133. DOI: 10.3390/cancers16061133. PMID: 38539468
Dragieva G, Prinz BM, Hafner J, et al. A randomised controlled clinical trial of topical photodynamic therapy with methyl aminolaevulinate in the treatment of actinic keratoses in transplant recipients. Br J Dermatol. 2004; 151(1): 196–200. DOI: 10.1111/j.1365-2133.2004.06054.x. PMID: 15270891
Antonetti P, Pellegrini C, Caponio C, et al. Photodynamic therapy for the treatment of Bowen’s disease: a review on efficacy, non-invasive treatment monitoring, tolerability, and cosmetic outcome. Biomedicines. 2024; 12(4): 795. DOI: 10.3390/biomedicines12040795. PMID: 38672152
Yélamos O, Braun RP, Liopyris K, et al. Dermoscopy and dermatopathology correlates of cutaneous neoplasms. J Am Acad Dermatol. 2019; 80(2): 341–363. DOI: 10.1016/j.jaad.2018.07.073. PMID: 30321581
Zalaudek I, Giacomel J, Schmid K, et al. Dermoscopy of facial actinic keratosis, intraepidermal carcinoma, and invasive squamous cell carcinoma: a progression model. J Am Acad Dermatol. 2012; 66(4): 589–597. DOI: 10.1016/j.jaad.2011.02.011. PMID: 21839538
Mun JH, Park JM, Song M, et al. The use of dermatoscopy to monitor therapeutic response of Bowen disease: a dermoscopic pathological study. Br J Dermatol. 2012; 167: 1382–1385. DOI: 10.1111/j.1365-2133.2012.11124.x. PMID: 22759263
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Laura Bernal Masferrer, Tamara Gracia Cazaña, Marcial Álvarez Salafranca, Isabel Bernad Alonso, Sara España Fernández de Valderrama, Mariana Claudia Matei, Francisco Javier Paul Ramos, Yolanda Gilaberte
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Dermatology Practical & Conceptual applies a Creative Commons Attribution License (CCAL) to all works we publish (http://creativecommons.org/licenses/by-nc/4.0/). Authors retain the copyright for their published work.
How to Cite
Share
