Dermatoscopic methods for the diagnosis of radiation-induced skin reactions in patients with primary skin lymphomas receiving total electron irradiation of the skin.

BACKGROUND: Timely diagnosis and assessment of the severity of radiation-induced skin reactions (RISR) is an urgent task of modern medicine. To date, the clinical assessment of radiation dermatitis has not been standardized. Use of imaging techniques to assess radiodermatitis may allow standardization of its clinical assessment.

AIMS: The aim of this study is to evaluate the dermatoscopic features and features of RD confocal microscopy data in patients who were prescribed RT, followed by an analysis of the clinical and morphological features of skin areas: before the start of the RT course and when reaching a total dose of 6, 14 and 30 Gy based on the obtained macroscopic and dermatoscopic photographs of the RISR for further comparison.

MATERIALS AND METHODS: The data of the study of morphological signs in the lesions of 40 patients of A.M. Granov Russian Central Cancer Center receiving a course of radiation therapy were analyzed. Dermoscopic evaluation of skin lesions was performed with a Heine Optotechnik (Germany) dermatoscope at tenfold magnification. Confocal spectroscopy was performed with VivaScope® 1500 (MAVIG GmbH, Munich, Germany). Instrumental data were correlated for statistical associations between dermatoscopic parameters and severity of RISR.

RESULTS: The dermatoscopy method revealed patterns characteristic of various degrees of RICR: the reticular arrangement of the vessels of the reticular dermis; brown squamous elements, perifollicular pigmentation and follicular plugs, characteristically arranged in the shape of rosettes. Confocal microscopy revealed non-stochastic skin changes: exocytosis (55%), spongiosis (65%), disordered disorganization of the epidermis (65%), abnormal dermal papillae (85%). The presence of low-contrast microvascular cells marking vascular dysfunction of the vascular bed of the skin is a specific feature of RD, detected regardless of severity.

CONCLUSIONS: Assessment of the degree of skin damage will optimize the management of patients undergoing radiation therapy. The findings are promising for integrating instrumental assessment methods into daily practice for early detection of ionizing radiation-induced skin changes and prediction of disease severity.