Clinical Olsen Grading Does Not Reflect Basal Growth in Actinic Keratoses: Two-Center Retrospective Analysis

Area of Science:

• Dermatology
• Oncology
• Histopathology

Background:

• Actinic keratosis (AK) is a precancerous lesion with unpredictable progression to cutaneous cancer.
• Histological basal proliferation patterns may indicate AK progression risk but are not clinically assessable.
• Current clinical markers for AK progression require further validation against histological features.

Purpose of the Study:

• To evaluate the correlation between clinical Olsen grading and pain with histological basal proliferation (PRO) in AK.
• To assess the association of clinical markers with other histological aspects of AK, including upward-directed growth and acantholysis.
• To determine the predictive value of clinical assessments for AK histological characteristics.

Main Methods:

• Retrospective analysis of 380 clinically diagnosed AKs across two centers.
• AKs were assessed using the clinical Olsen classification (I-III) and palpation for pain.
• Histological evaluation included basal (PRO I-III) and upward-directed (AK I-III) growth patterns, and acantholysis.

Main Results:

• Olsen grading showed a weak correlation with histological PRO classification (Spearman's rho = 0.136, p = 0.008).
• Pain upon palpation was significantly associated with higher PRO grades (p = 0.005) and the presence of acantholysis (p = 0.023).
• No significant association was found between pain and Olsen grades or upward-directed growth patterns.

Conclusions:

• Olsen grading is not a reliable clinical predictor of basal proliferation patterns in actinic keratosis.
• While Olsen grading may imply progression relevance, this study found no substantiated link to histological transformation indicators.
• Pain in AK lesions is a significant clinical indicator correlating with high-grade basal proliferation and acantholysis, suggesting its potential as a marker for lesion aggressiveness.