ABSTRACT Introduction Actinic keratoses (AKs) are ultraviolet (UV)‐induced skin lesions that may progress to invasive squamous cell carcinoma. Hyperkeratotic AKs hinder line‐field confocal optical coherence tomography (LC‐OCT) imaging, limiting assessment of the dermal‐epidermal junction (DEJ) and PRO‐score, a histopathological index of dermal invasion. Objective The aim of this study was to evaluate whether moisturization improves DEJ visualization and PRO‐score evaluation in hyperkeratotic AKs using LC‐OCT. Materials and Methods Fifty‐nine hyperkeratotic AKs were randomized to receive either 20‐min tap water occlusion or 20% salicylic acid ointment (SAO). LC‐OCT scans were taken before and after treatment. DEJ visibility, PRO‐score (0–3), and confidence in PRO assignment (cPRO) were rated by blinded evaluators. Results DEJ visibility significantly increased posttreatment (from 39.0% to 86.4%, p = 0.015), with no significant difference between water and salicylic acid ointment (SAO). Confidence in PRO‐scoring also improved ( p < 0.001), and 39.1% of lesions with initial scores were reclassified. G2 AKs had higher DEJ visibility than G3 both before and after treatment. Conclusion Moisturization enhances LC‐OCT evaluation of hyperkeratotic AKs, improving DEJ visualization and diagnostic confidence.
Michelini et al. (Wed,) studied this question.