Actinic keratosis: correlation between clinical and histological classification systems

Area of Science:

• Dermatology
• Oncology
• Histopathology

Background:

• Actinic keratosis (AK) is graded using clinical (Olsen) and histological (Roewert-Huber) systems.
• These systems assess lesion thickness, hyperkeratosis, and atypical keratinocytes.

Purpose of the Study:

• To determine the correlation between the Olsen clinical and Roewert-Huber histological classification systems for AK.
• To assess the accuracy of clinical grading in predicting histological findings.

Main Methods:

• 892 AK lesions were assessed clinically (Olsen grades 1-3) and histologically (Roewert-Huber AK I-III).
• A match was defined as Olsen grade 1 = AK I, 2 = AK II, 3 = AK III.
• Spearman's rank correlation coefficient was calculated.

Main Results:

• 53.8% of lesions showed matching clinical and histological grades.
• The most frequent match was Olsen grade 2 = AK II (83.1% of matches).
• Spearman's correlation coefficient was weak (r = 0.0499, P = 0.137), indicating poor agreement.

Conclusions:

• The Olsen clinical classification does not accurately predict Roewert-Huber histological grading for AK.
• Clinical appearance alone is insufficient to determine AK histology.
• All AK lesions and field cancerization require treatment, irrespective of clinical grade.