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The study develops a qualitative and quantitative visual diagnostic tool using reflectance confocal microscopy (RCM) to identify AK cellular attributes and their severity, and to support assessment of disease evolution or treatment response via image analysis. A literature-based transformation level scale is validated in 21 clinically diagnosed subjects and tested before and after 90 days of topical therapy with retinoic acid or placebo.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/photographic-scale-for-the-characterization-of-actinic-keratosis-through-reflectance-confocal-microscopy-a-quantitative-approach-to-cellular-transformation/328968/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/photographic-scale-for-the-characterization-of-actinic-keratosis-through-reflectance-confocal-microscopy-a-quantitative-approach-to-cellular-transformation/328968.png","ImageObject",300,407,{"name":92,"@type":93},"Miles","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-08","2026-09-21",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the main goal of the photographic scale for AK?","Question",{"text":112,"@type":113},"To create a qualitative and quantitative visual diagnostic tool that captures the characteristics and severity of key cellular attributes of actinic keratosis using reflectance confocal microscopy and image analysis.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was the scale validated in the study?",{"text":117,"@type":113},"The study performed a preliminary characterization with 21 subjects clinically diagnosed with AK, classifying attributes across skin layers and testing the diagnostic accuracy of the scale.",{"name":119,"@type":110,"acceptedAnswer":120},"How was treatment response evaluated?",{"text":121,"@type":113},"Subjects were divided into retinoic acid and placebo groups and evaluated with confocal reflectance microscopy and dermoscopy-quality digital imaging before and after 90 days of treatment.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},328968,1790012870,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},13056703019404,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","OPEN ACCESS  \nEDITED BY  \nNatallia E. Uzunbajakava, Netherlands Organisation for Applied Scientific Research, Netherlands  \nREVIEWED BY  \nMara Madalina Mihai,  \n“Carol Davila” University of Medicine and Pharmacy, Romania  \nIgor Jarosław Feszak,  \nPomeranian University of Slupsk, Poland  \n*CORRESPONDENCE  \nGislaine Ricci Leonardi  \n [gislaine.leonardi@fcf.unicamp.br](gislaine.leonardi@fcf.unicamp.br)  \nRECEIVED 26 February 2024  \nACCEPTED 05 August 2024  \nPUBLISHED 04 September 2024  \nCITATION  \nGuerra LO, Leão Santos AC, Cortinoz JR, Magalhães RF, Vasques LI and  \nLeonardi GR (2024) Photographic scale for the characterization of actinic keratosis through reflectance confocal microscopy: a quantitative approach to cellular transformation.  \nFront. Med. 11:1391859.  \ndoi: 10.3389/fmed.2024.1391859  \nCOPYRIGHT  \n© 2024 Guerra, Leão Santos, Cortinoz, Magalhães, Vasques and Leonardi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.  \nTYPE Original Research PUBLISHED 04 September 2024 DOI 10.3389/fmed.2024.1391859  \nPhotographic scale for the characterization of actinic keratosis through reflectance confocal microscopy: a quantitative approach to cellular transformation  \nLucas Offenbecker Guerra 1,2, Ana Carolina Leão Santos 2,3, Janaina Rosa Cortinoz 2, Renata Ferreira Magalhães 1,4, Louise Idalgo Vasques3 and Gislaine Ricci Leonardi 1,3*  \n1 Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil, 2ALS-Allergisa Pesquisa Dermato-Cosmetica Ltda., Campinas, Brazil, 3 Faculty of Pharmaceutical Sciences, University of Campinas (UNICAMP), Campinas, Brazil, 4 Dermatology Outpatient Clinic, Clinics Hospital, University of Campinas (UNICAMP), Campinas, Brazil  \nBackground: Actinic keratosis (AK) is a highly prevalent pre-cancerous skin lesion that often leads to cutaneous squamous cell carcinoma. There are different stages of evolution of the disease and several features that characterize keratosis. This study aimed to develop a qualitative and quantitative visual diagnostic tool to facilitate the identification of the characteristics and severity of the main cellular attributes of AK and to show its applicability in evaluating the evolution or treatment through image analysis.  \nMethods: Literature research on the main scientific databases and in the institute’s database was carried out to gather all the different levels of cellular transformation. To validate the scale, a preliminary characterization study was carried out with 21 subjects who had clinically diagnosed AK lesions to classify the attributes in each skin layer and test the accuracy of the diagnosis of the scale. Afterward, and to show the possibility of a follow-up with a topical treatment, the subjects were divided into two treatment groups, receiving either a cream formulation containing retinoic acid, or a placebo formula. The evaluation was carried out through confocal reflectance microscopy and a digital camera with dermoscopic quality before and after 90 days of treatment.  \nResults: A table detailing the 18 attributes of AK, and a photographic scale containing RCM images graded by scores established for each characteristic and the frequency of spreading were developed. The results of the validation presented good repeatability, correlation with clinical evaluation, and capacity for differentiating treatments demonstrated by the significant improvement after topical treatment by the reduction of the score for 10 out of the 18 attributes. The preliminary study, evaluated by the detailed transformation scale highlights  \nimportant differences in the su","cbCaima9szbf27zz","https://ap.wps.com/l/cbCaima9szbf27zz","pdf",10168912,13,"English","# Background\n## Definition, prevalence, and characteristics of actinic keratosis\n# Methods\n## Scale development and validation\n## Topical treatment follow-up design","[{\"question\":\"What is the main goal of the photographic scale for AK?\",\"answer\":\"To create a qualitative and quantitative visual diagnostic tool that captures the characteristics and severity of key cellular attributes of actinic keratosis using reflectance confocal microscopy and image analysis.\"},{\"question\":\"How was the scale validated in the study?\",\"answer\":\"The study performed a preliminary characterization with 21 subjects clinically diagnosed with AK, classifying attributes across skin layers and testing the diagnostic accuracy of the scale.\"},{\"question\":\"How was treatment response evaluated?\",\"answer\":\"Subjects were divided into retinoic acid and placebo groups and evaluated with confocal reflectance microscopy and dermoscopy-quality digital imaging before and after 90 days of treatment.\"}]","Photographic scale for the characterization of actinic keratosis through reflectance confocal microscopy: a quantitative approach to cellular transformation | PDF",1789981860,33]