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Hautkrankheiten werden in Deutschland stationär vorwiegend in den 115 Hautkliniken versorgt.Versorgungswissenschaftliche und gesundheitsökonomische Analyse der dermatologischen stationären Versorgung und Prädiktion des zukünftigen Versorgungsbedarfes auf der Basis von Primär- und Sekundärdaten.Die ambulante und stationäre Versorgung der dermatologischen Behandlungsindikationen wird überwiegend durch Fachärzte für Dermatologie getragen. Stationär wurden 2018 833 491 Fälle behandelt, entsprechend 4,21 % aller stationären Fälle (19 808 687). Häufigste Behandlungsfälle waren: epithelialer Hautkrebs (gesamt 87 386, davon dermatologische Kliniken 52 608), gefolgt von Melanom (23 917/17 774), Psoriasis (19 291/13 352), Erysipel (73 337/11 260), sonstige Dermatitis (12 671/10 842), atopisches Ekzem (11 421/9734) und Herpes zoster (26 249/9652). Mit einer durchschnittlichen Verweildauer von 5,69 Tagen befanden sich die dermatologischen Kliniken im unteren Drittel. Der Anteil der in Hautkliniken versorgten stationären Indikationen war am höchsten bei Prurigo (95,2 %), Pemphigus (94,9 %), Parapsoriasis (94,6 %), Pemphigoid (90,3 %), Dermatitiden (85,6 %) und atopischem Ekzem (85,2 %). Während die Gesamtzahl der stationären Behandlungsfälle in Deutschland zwischen 2000 und 2018 um durchschnittlich 17,5 % gestiegen ist, ist dies bei Hautkrankheiten zu 26,6 % der Fall, bei einzelnen zu über 150 %. Die Projektion der heutigen auf die zukünftige stationäre Versorgung lässt einen weiterhin hohen Bedarf an stationärer Versorgung durch die Hautkliniken erwarten.Die stationäre dermatologische Versorgung ist auch zukünftig ein unerlässlicher Bestandteil der qualifizierten, sozialrechtlich notwendigen Versorgung in Deutschland.

Background In Germany, skin diseases are mainly treated in the 115 dermatological hospitals. Methods Health care and health economic analysis of dermatological inpatient care and prediction of future care needs based on primary and secondary data. Results Outpatient and inpatient care for dermatologic treatment indications is predominantly provided by dermatology specialists. Inpatient treatment was provided for 833,491 cases in 2018, corresponding to 4.21 % of all inpatient cases (19,808,687). Most common treatment cases were: epithelial skin cancer (total 87,386, of which dermatology clinics 52,608), followed by melanoma (23,917/17,774), psoriasis (19,291/13,352), erysipelas (73,337/11,260), other dermatitis (12,671/10,842), atopic dermatitis (AD) (11,421/9,734), and herpes zoster (26,249/9,652). With an average length of stay of 5.69 days, dermatology hospitals were in the bottom third. The proportion of inpatient indications cared for in dermatology hospitals was highest for prurigo (95.2 %), pemphigus (94.9 %), parapsoriasis (94.6 %), pemphigoid (90.3 %), eczema other than AD (85.6 %), and AD (85.2 %). While the total number of inpatient treatment cases in Germany has increased by an average of 17.5 % between 2000 and 2018, this is the case for 26.6 % of skin diseases and over 150 % for individual ones. The projection of current to future inpatient care suggests a continued high demand for inpatient care by dermatology hospitals. Conclusion Inpatient dermatological care will continue to be an indispensable component of qualified, socially necessary care in Germany.

Die stationäre Versorgung in Deutschland ist seit Einführung des DRG-gestützten Entgeltsystems einem Wandel unterworfen. Über wichtige Differenzierungsfaktoren wie das Versorgungsspektrum und die personelle Situation in den Hautkliniken lagen bislang keine Publikationen vor.Versorgungswissenschaftliche Analyse der 115 Hautkliniken im Oktober 2019 mittels eines strukturierten Erhebungsbogens.Das Versorgungsspektrum umfasste durchschnittlich zu 31,0 % allgemeine Dermatologie, 33,6 % operative Dermatologie, 15,6 % Onkologie und 10,1 % Allergologie. Die Kliniken wiesen durchschnittlich 14 Vollzeitstellen und 3 Teilzeitstellen auf (Universitätskliniken: 23/5, nicht universitäre Kliniken: 9/2). Der mittlere Frauenanteil der Ärzteteams betrug: Weiterbildungsärztinnen 73,3 %, Oberärztinnen 53,0 %, Direktorinnen 20,0 %. Die Bewerbersituation der Ober- und Fachärzte wurde überwiegend als schlecht, die der Assistenzärzte als vornehmlich gut bewertet. Schlechtere Bewerbersituationen lagen in den nicht universitären Kliniken sowie in ländlichen Räumen vor. Die Zufriedenheit der ärztlichen Direktoren mit den aktuellen Rahmenbedingungen der stationären Versorgung zeigte unabhängig von Universitätsklinik und nicht universitärer Klinik eine variable Einschätzung. Die Gefährdung der stationären Versorgung wurde jedoch überwiegend als niedrig eingeschätzt (71,6 %).Die Gesamtsituation der stationären dermatologischen Versorgung ist als überwiegend gut einzuordnen. Auch weisen die Hautkliniken weit überwiegend eine große Versorgungsbreite hinsichtlich der Vielfalt an Indikationen auf. Die teilweise als unzureichend bewerteten Rahmenbedingungen erfordern weitergehende Maßnahmen.

Das Pyoderma gangraenosum (PG) ist eine autoinflammatorische Erkrankung, die zur Ulzeration der Haut fuhrt. Sie sollte in der Differenzialdiagnostik von Ulkuserkrankungen berucksichtigt werden. Welche Charakteristika grenzen das PG von anderen ulzerativen Hauterkrankungen ab? Es wurde eine Literaturrecherche durchgefuhrt und die S1-Leitlinie Pyoderma gangraenosum herangezogen. Klinische Manifestationen und Verlaufe werden anhand von Fallbeispielen dargestellt. Das PG ist eine seltene, aber schwerwiegende primar sterile nekrotisierende Hauterkrankung, die im Rahmen von Syndromen und assoziiert mit Komorbiditaten aus dem autoinflammatorischen Spektrum auftreten kann. Die Diagnose wird in der Regel klinisch gestellt. Nicht selten ist das PG eine Ausschlussdiagnose. 70 % der Ulzera treten an den Unterschenkeln auf. Zu den Therapiemoglichkeiten zahlen Immunsuppressiva und Biologika. Das PG ist eine wichtige Differenzialdiagnose von Unterschenkelulzera und sollte in Betracht gezogen werden, wenn entsprechende Komorbiditaten vorliegen und andere Ursachen ausgeschlossen wurden.

Background: Dynamic optical coherence tomography (D-OCT) allows in vivo visualization of blood vessels in the skin and in malignant tumours. Vessel patterns in malignant melanoma may be associated with tumour stage. Objective: The aim of this study was to describe blood vessel patterns in melanomas and to correlate them with stage. Methods: One hundred fifty-nine malignant melanomas were assessed in a multicentre study. Every tumour was imaged using D-OCT prior to surgery and histologic evaluation. The tumour data such as thickness and ulceration as well as the staging at primary diagnosis and a follow-up of at least 40 months resulted in a stage classification. The vessel patterns were assessed according to predefined categories, compared with healthy adjacent skin, and correlated to stage. Results: Melanomas contained more blood vessels in different patterns compared with healthy adjacent skin. In particular, irregular vascular shapes such as blobs, coils, curves and serpiginous vessels were more common in melanomas. In addition, these patterns were significantly more often found in high-risk and metastatic melanomas than in low-risk lesions. Conclusion: In melanomas, the density of the blood vessels is increased, and irregular vascular patterns are more frequent. At higher stages, especially in metastatic melanomas, these atypical vessels are significantly more common.

Purpose Uveal melanoma (UM) is an orphan cancer of high unmet medical need. Current patterns of care and surveillance remain unclear as they are situated in an interdisciplinary setting. Methods A questionnaire addressing the patterns of care and surveillance in the management of patients with uveal melanoma was distributed to 70 skin cancer centers in Austria, Germany and Switzerland. Frequency distributions of responses for each item of the questionnaire were calculated. Results 44 of 70 (62.9%) skin cancer centers completed the questionnaire. Thirty-nine hospitals were located in Germany (88.6%), three in Switzerland (6.8%) and two in Austria (4.5%). The majority (68.2%) represented university hospitals. Most patients with metastatic disease were treated in certified skin cancer centers (70.7%, 29/41). Besides, the majority of patients with UM were referred to the respective skin cancer center by ophthalmologists (87.2%, 34/39). Treatment and organization of follow-up of patients varied across the different centers. 35.1% (14/37) of the centers stated to not perform any screening measures. Conclusion Treatment patterns of patients with uveal melanoma in Germany, Austria and Switzerland remain extremely heterogeneous. A guideline for the treatment and surveillance is urgently needed.

During the development of cosmetic formulations, in vitro and in vivo methods are essential tools used to reliably assess the skin irritation potential of a product or ingredient. Epicutaneous patch testing (single and/or multiple application protocols) has long been used as an initial in vivo method to screen for possible skin irritation properties of a substance or formulation. To confirm the mildness and dermatological and/or consumer acceptance of a product, use tests are often subsequently conducted. A study was therefore initiated to see how well patch test results correlate with use tests with respect to irritation elicited by skincare (leave-on) products.A number of different cosmetic formulations were assessed in both tests. Although the patch test results did not indicate substantial irritation potentials, immediate-type reactions (stinging and redness) were observed in some volunteers which disappeared within approx. 1 h. Although transient, these reactions suggested that consumer acceptance would probably be low and the studies were discontinued. Immediate-type reactions are rare but have been described for some substances used in cosmetics. These unexpected results were nevertheless intriguing and prompted the start of a journey to see if patch test protocols could be modified to assess these reactions. An occlusive short-term patch test protocol with an application period of 20 min was developed. Successful identification of the spontaneous reactions became possible. Furthermore, there was a correlation between the intensity of reactions observed in the short-term patch test and those observed in the controlled in-use studies. Short-term patch testing using the developed protocol can therefore reliably be used as a screening method, for example in the development and optimization of cosmetic formulations containing ingredients that could cause spontaneous reactions, for instance of non-immunological contact urticaria type.The lessons learned from this studies indicate that simple modifications of existing test protocols can lead to important insights into skin reactions. These modifications can then be used to create further building blocks in the development and optimization of test strategies for cosmetic formulations which offer reliable study designs for possible reactions product developers may encounter.Lors du développement de formulations cosmétiques, les méthodes in vitro et in vivo sont des outils essentiels utilisés pour évaluer de manière fiable le potentiel d'irritation cutanée d'un produit ou d'un ingrédient. Le test épicutané (protocoles d'application uniques et / ou multiples) est utilisé depuis longtemps comme méthode initiale in vivo pour dépister les éventuelles propriétés d'irritation cutanée d'une substance ou d'une formulation. Afin de confirmer la douceur et l'acceptation dermatologique et / ou consommateur d'un produit, des tests d'usage sont souvent effectués ultérieurement. Une étude a donc été initiée pour voir dans quelle mesure les résultats des tests épicutanés correspondent aux tests d'usage en ce qui concerne l'irritation provoquée par les produits de soin (sans rinçage). MÉTHODES/RÉSULTATS: Un certain nombre de formulations cosmétiques différentes ont été évaluées dans les deux tests. Bien que les résultats du test épicutané n'indiquent pas de potentiels d'irritation substantiels, des réactions de type immédiat (picotements et rougeurs) ont été observées chez certains volontaires. Celles-ci ont disparu en à peu près 1 heure. Bien que transitoires, ces réactions de type 5 suggéraient que l'acceptation du consommateur serait probablement faible et les études ont été interrompues. Les réactions de type immédiat 6 sont rares mais ont été évoquées en relation avec certaines substances utilisées en cosmétique. Ces résultats inattendus étaient néanmoins intrigants et ont incité le lancement d’un processus pour voir si les protocoles de test épicutané pouvaient être modifiés pour évaluer ces réactions. Un protocole de test épicutané à court terme occlusif avec une période d'application de 20 min a été développé, permettant l'identification réussie des réactions spontanées. Il a été de plus constate une corrélation entre l'intensité des réactions observées dans le test épicutané à court terme et celles observées dans les test d’usage contrôlés. Le test épicutané à court terme utilisant le protocole développé peut donc être utilisé de manière fiable comme méthode de dépistage, par exemple dans le développement et l'optimisation de formulations cosmétiques contenant des ingrédients qui pourraient provoquer des réactions spontanées, par exemple de type urticaire de contact non immunologique.Les leçons tirées de ces études indiquent que de simples modifications des protocoles de test existants peuvent révéler des informations importantes sur les réactions cutanées. Ces modifications peuvent ensuite être utilisées pour créer d'autres blocs de construction dans le développement et l'optimisation de stratégies de test pour des formulations cosmétiques qui offrent des conceptions d'études fiables pour les réactions possibles que les développeurs de produits peuvent rencontrer.

In der taglichen Praxis konnen Nagelpigmentierungen eine diagnostische Herausforderung darstellen, insbesondere wenn sie dermatoskopisch unspezifische Veranderungen zeigen. Wir stellen exemplarische Falle vor, bei denen die optische Koharenztomographie als schnelle, nichtinvasive bildgebende Methode typische Veranderungen zeigte, die hinweisend fur die Diagnose waren.

BACKGROUND Actinic keratoses (AKs) can histologically be classified by the extent of atypical keratinocytes throughout the epidermis or their pattern of basal proliferation. Currently, no data on the inter-rater reliability of both scores is available. OBJECTIVE To evaluate the inter-rater reliability of the two classification schemes; histological grade (AK I-III) and basal proliferation (PRO I-III). METHODS Histological images of 54 AKs were classified by 21 independent dermatopathologists with regard to basal proliferation (PRO I-III), histological grade (AK I-III) and assumed risk of progression into invasive carcinoma. RESULTS Overall, of the 54 AKs 16.7% (9/54) were classified as AK I, 66.7% (36/54) as AK II, and 16.7% (9/54) as AK III. With regards to basal growth pattern, 25.9% (14/54) were classified as PRO I, 42.6% (23/54) as PRO II, and 31.5% (17/54) as PRO III. We observed a highly significant inter-rater reliability for PRO-grading (P < 0.001) which was higher than for AK-grading (Kendall's W coefficient: AK = 0.488 vs. PRO = 0.793). We found substantial agreement for assumed progression risk for AKs with worsening basal proliferation (k = 0.759) compared to moderate agreement (k = 0.563) for different AK-gradings. CONCLUSIONS Histological classification of basal growth pattern (PRO) showed higher inter-rater reliability compared to the established classification of atypical keratinocytes throughout epidermal layers. Moreover, experienced dermatopathologists considered basal proliferation to be more important in terms of progression risk than upwards directed growth patterns. It should be considered to classify AKs according to their basal proliferation pattern (PRO I-III).

Basal cell carcinoma (BCC) is the most common malignant tumor among fair-skinned individuals, and its incidence had been steadily rising in the past decades. In order to maintain the highest quality of patient care possible, the German S2k guidelines were updated following a systematic literature search and with the participation of all professional societies and associations involved in the management of the disease. Part 2 addresses issues such as proper risk stratification, the various therapeutic approaches, and prevention as well as follow-up of patients with basal cell carcinoma.

BACKGROUND Basal cell carcinoma (BCC) is the most common skin cancer in the general population. Treatments vary from Mohs surgery to topical therapy, depending on the subtype. Dermoscopy, reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) have gained a foothold in daily clinical practice to optimize diagnosis and subtype-oriented treatment. The new technique of line-field confocal OCT (LC-OCT) allows imaging at high resolution and depth, but its use has not yet been investigated in larger studies. AIM To evaluate the main LC-OCT criteria for the diagnosis and subtyping of BCC compared with histopathology, OCT and RCM. METHODS In total, 52 histopathologically confirmed BCCs were evaluated for imaging criteria. Their frequency, predictive values and ROC curves were calculated. A multinominal regression with stepwise variables selection to distinguish BCC subtypes was performed. RESULTS Nodular BCCs were mainly characterized by atypical keratinocytes, altered dermoepidermal junction (DEJ), tumour nests in the dermis, dark clefting, prominent vascularization and white hyper-reflective stroma. Superficial BCCs showed a thickening of the epidermis due to a series of tumour lobules with clear connection to the DEJ (string of pearls pattern). Infiltrative BCCs were characterized by elongated hyporeflective tumour strands, surrounded by bright collagen (shoal of fish pattern). The overall BCC subtype agreement between LC-OCT and conventional histology was 90.4% (95% CI 79.0-96.8). CONCLUSION LC-OCT allows noninvasive, real-time identification of BCCs and their subtypes in vertical, horizontal and three-dimension mode compared with histology, RCM and OCT. Further larger studies are needed to better explore the clinical applications of this promising device.

Die neue M‑WBO (Musterweiterbildungsordnung) wurde 6 Jahre lang entwickelt und zum 01.07.2020 von den meisten LAK (Landesarztekammern) in Kraft gesetzt. Die kunftige Weiterbildung zum Hautarzt ist kompetenzorientiert. Dies soll beobachtbare, erfolgreiche Problemlosungen in der Praxis ermoglichen. Damit ist der Kompetenzerwerb nur davon abhangig, ob das Ziel erreicht wurde. Zur Feststellung des Erreichens der jeweiligen Kompetenzen sind neue Verfahren notig, u.a. jahrliche Weiterbildungsgesprache, arbeitsplatzbasierte Prufungen und ein eLogbuch (elektronisches Logbuch). Stationare Mindestzeiten entfallen kunftig. Die Weiterbildung kann prinzipiell komplett ambulant erfolgen. Die M‑WBO Dermatologie umfasst 14 thematische Blocke mit differenzierter Beschreibung von kognitiven und Methoden- bzw. Handlungskompetenzen. Die Richtzahlen dermatologischer Zusatzweiterbildungen wurden erheblich in die Zeit der Grundweiterbildung verschoben. Zusatzweiterbildungen konnen berufsbegleitend erworben werden. Fachlich empfohlene Weiterbildungsplane (FEWP) sind die konkreten Ausfuhrungsbestimmungen der M‑WBO. Sie sind kein Teil der WBO und konnen angepasst werden. Im Zusammenhang mit diesem neuen Ansatz sind derzeit noch zahlreiche Fragen offen, wie Dokumentation in der Praxis oder Finanzierung.

Simple Summary Actinic keratoses (AKs) are extremely common in the elderly population; they are universally recognized as precursors of invasive squamous cell carcinoma, and their risk of progression relates to the basal growth pattern of keratinocytes in the histological slides, based on a model called “PRO” classification. Since AKs can be investigated at bedside with non-invasive devices such the new line-field confocal optical coherence tomography (LC-OCT), we hypothesized that it was also possible to use such devices for reproducing the PRO classification and assessing the progression risk of AK without an invasive biopsy. In this pilot study, we demonstrated the feasibility of the LC-OCT severity grading of AKs based on the histological PRO classification, obtaining a good correlation between the two models and strong interobserver agreement. Abstract It is known that actinic keratoses (AKs) can progress to invasive squamous cell carcinoma (SCC). The histological PRO grading of AKs is based on the growth pattern of basal keratinocytes and relates to their progression risk. AKs can be non-invasively characterized by line-field confocal optical coherence tomography (LC-OCT). The aim of the study was to define criteria for an LC-OCT grading of AKs based on the PRO classification and to correlate it with its histological counterpart. To evaluate the interobserver agreement for the LC-OCT PRO classification, fifty AKs were imaged by LC-OCT and biopsied for histopathology. PRO histological grading was assessed by an expert consensus, while two evaluator groups separately performed LC-OCT grading on vertical sections. The agreement between LC-OCT and histological PRO grading was 75% for all lesions (weighted kappa 0.66, 95% CI 0.48–0.83, p ≤ 0.001) and 85.4% when comparing the subgroups PRO I vs. PRO II/III (weighted kappa 0.64, 95% CI 0.40–0.88, p ≤ 0.001). The interobserver agreement for LC-OCT was 90% (Cohen’s kappa 0.84, 95% CI 0.71–0.91, p ≤ 0.001). In this pilot study, we demonstrated that LC-OCT is potentially able to classify AKs based on the basal growth pattern of keratinocytes, in-vivo reproducing the PRO classification, with strong interobserver agreement and a good correlation with histopathology.

BACKGROUND Inpatient care in Germany has been subject to change since the introduction of the DRG-based payment system. There have been no publications on important differentiating factors such as the spectrum of care and the staffing situation in dermatology. METHODS Health care analysis of 115 dermatology hospitals in October 2019 using a structured survey questionnaire. RESULTS On average, the spectrum of care included 31.0 % general dermatology, 33.6 % surgical dermatology, 15.6 % oncology, and 10.1 % allergology. The clinics had an average of 14 full-time positions and 3 part-time positions (university clinics: 23/5, non-university clinics: 9/2). The mean nationwide proportion of women in the physician teams showed the following distribution: postgraduate physicians 73.3 %, senior physicians 53.0 %, directors 20.0 %. The applicant situation of senior physicians and specialists was assessed as predominantly poor, that of residents as predominantly good. Worse applicant situations were present in non-university hospitals and in rural areas. The satisfaction of the medical directors with the current conditions of inpatient care showed a variable assessment independent of university hospital and non-university hospital status. However, the threat to inpatient care was predominantly assessed as low (71.6 %). CONCLUSIONS The overall situation of inpatient dermatological care can be classified as predominantly good. In addition, the majority of dermatology clinics provide a wide range of care with regard to the variety of indications. The general conditions, which in some cases are rated as inadequate, require further measures.

Optical coherence tomography (OCT) has been able to establish itself in recent years not only in academic-scientific, but also in everyday dermatological practice. Its focus lies on epithelial tumors of the skin, which can be diagnosed intuitively and within a few seconds. Thus, basal cell carcinomas, actinic keratoses, and different stages of field cancerization can be diagnosed and monitored for response to therapy or possible recurrence. This often helps to avoid invasive sample extraction. Recently, the field of OCT and its latest advancement, dynamic OCT (D-OCT), has been expanded to include non-oncologic dermatological diseases. This encompasses inflammatory dermatoses and the analysis of physiological skin parameters such as hydration. Thanks to automated vascular imaging and the measurement of objective parameters such as epidermal thickness, blood flow at depth, optical attenuation coefficient, and skin roughness, more and more characteristics of the skin can be studied in a noninvasive and standardized way. New potential areas of application are eczema, contact allergic dermatitis, psoriasis, rosacea, telangiectasia, acute and chronic wounds, melasma and nevus flammeus but also melanocytic lesions.

Optical coherence tomography (OCT) and confocal laser microscopy (CLSM) are established non-invasive methods in clinical dermatological routine diagnosis. Whereas CLSM is especially useful to distinguish between nevi and melanoma, OCT is suitable for the diagnosis and differentiation of non-melanoma skin cancer. Line-field confocal optical coherence tomography (LC-OCT) is a new innovative device, which has better cellular resolution than OCT and a higher penetration depth than CLSM. Similar to CLSM, LC-OCT also allows 3D images in real time to be taken. Therefore LC-OCT is very useful for the examination of skin lesions of all kinds, since it unites the features of CLSM and OCT.

Die optische Koharenztomographie (OCT) und die konfokale Lasermikroskopie (KLM) ermoglichen eine nichtinvasive bildgebende Diagnostik der Haut. Gerade weil bei Kindern die Indikation fur eine Hautbiopsie eher zuruckhaltend gestellt wird, konnen OCT und KLM fur die Abklarung von kindlichen Hautveranderungen hilfreich sein. Auserdem stellen Biopsien immer nur eine Momentaufnahme eines kleinen Bezirkes der Haut dar, wahrend die nichtinvasiven Methoden ermoglichen, mehrere Lokalisationen im Zeitverlauf zu untersuchen, sodass auch dynamische Veranderungen und Therapieverlaufe sichtbar gemacht werden konnen. In der padiatrischen Dermatologie eignen sie sich insbesondere zur Abklarung atypischer Pigmentlasionen, bei infektiosen Dermatosen wie Skabies oder Tinea und zur Diagnostik entzundlicher und degenerativer Dermatosen.

Background The treatment of keratinocyte cancers (KC) strictly depends on their differentiation and invasiveness. Non-invasive diagnostic techniques can support the diagnosis in real time, avoiding unnecessary biopsies. This study aimed to preliminarily define main imaging criteria and histological correlations of actinic keratosis (AK), Bowen's disease (BD) and squamous cell carcinoma (SCC) using the novel device line-field confocal optical coherence tomography (LC-OCT). Methods Dermoscopy and LC-OCT images of 73 histopathologically confirmed lesions (46 AKs, 11 BD and 16 SCCs) were included in the study. Exemplary lesions (10 AKs, 5 BD and 5 SCCs) were additionally investigated with optical coherence tomography and reflectance confocal microscopy. Results Most common LC-OCT findings of KC in the descriptive statistics were hyperkeratosis/parakeratosis, disruption of stratum corneum, broadened epidermis, basal and suprabasal keratinocyte atypia, dilated vessels/neoangiogenesis and elastosis/collagen alterations. In the univariate multinomial logistic regression, a preserved DEJ was less common in SCC compared with AK and BD, BD displayed marked keratinocyte atypia involving all epidermal layers (bowenoid pattern), while SCC showed ulceration, increased epidermal thickness, keratin plugs, acantholysis, not visible/interrupted DEJ and epidermal bright particles. LC-OCT increased the diagnostic confidence by 24.7% compared with dermoscopy alone. Conclusions Our study describes for the first time specific LC-OCT features of different stages of KC and their histopathological correlates, focusing on keratinocyte morphology and architecture of the epidermis and DEJ. LC-OCT may open new scenarios in the bedside diagnosis, treatment planning and follow-up of KC.

Background Considerable parts of the global population are affected by androgenetic alopecia (AGA). Aims The efficacy of a foam containing nicotinic acid hexyl ester, polyphenols, zinc, glycine, and caffeine in comparison with a vehicle control foam was assessed in a double-blind vehicle-controlled study in men with AGA over 6 months. Patients/methods Sixty-two men with AGA were assigned either to the active ingredients (verum) or the vehicle group. They applied the products twice daily on affected scalp areas over 6 months. Automated phototrichograms were obtained at baseline, after 3 and 6 months. In addition, a clinical rating by a dermatologist and by the subjects themselves was documented using standardized questionnaires. Results The reduction of the telogen rate from T0 to T6 was significantly stronger in the verum group compared to the vehicle group. The reduction was significant from T0 to T3 and T6 in the verum group, but in the vehicle group only from T0 to T3, not to T6. Significantly increased hair density was noticed in both groups at all time points, but the change from T0 to T6 did not differ significantly between the groups. Cosmetic acceptance of the foam and its application regimen was generally good in both groups. Slight reddening and burning after application of verum in six cases was probably due to the presence of hexyl nicotinate. Conclusion The study demonstrated a reduction of the telogen rate by a cosmetic foam in men affected by AGA, indicating a benefit for cosmetic intervention against male pattern hair loss.

The amount of training needed to correctly interpret optical coherence tomography scans of the skin is undefined. The aim of this study was to illustrate how cumulative sum charts can be used to determine how many optical coherence tomography scans novice assessors should evaluate in order to obtain competence in diagnosing basal cell carcinoma. Four hundred lesions suspected for non-melanoma skin cancer were evaluated by optical coherence tomography in combination with clinical photographs, using a 5-point confidence scale. The diagnostic error rate (sum of false-negative and false-positive optical coherence tomography results/total number of cases) was used to evaluate performance, with histopathological diagnosis as the reference standard. Acceptable and unacceptable error rates were set at 16% and 25%, respectively. Adequate performance was reached after assessing 183-311 scans, dependent on the cut-off for a positive test result. In conclusion, cumulative sum analysis is useful to monitor the progress of optical coherence tomography trainees. The caseload necessary for training is substantial.

Actinic keratoses (AKs) are common lesions in light-skinned individuals that can potentially progress to cutaneous squamous cell carcinoma (cSCC). Both conditions may be associated with significant morbidity and constitute a major disease burden, especially among the elderly. To establish an evidence-based framework for clinical decision making, the guidelines for actinic keratosis and cutaneous squamous cell carcinoma were developed using the highest level of methodology (S3) according to regulations issued by the Association of Scientific Medical Societies in Germany (AWMF). The guidelines are aimed at dermatologists, general practitioners, ENT specialists, surgeons, oncologists, radiologists and radiation oncologists in hospitals and office-based settings as well as other medical specialties involved in the diagnosis and treatment of patients with AKs and cSCC. The guidelines are also aimed at affected patients, their relatives, policy makers and insurance funds. In the second part, we will address aspects relating to epidemiology, etiology, surgical and systemic treatment of cSCC, follow-up and disease prevention, and discuss AKs and cSCC in the context of occupational disease regulations.

Actinic keratoses (AK) are common lesions in light‐skinned individuals that can potentially progress to cutaneous squamous cell carcinoma (cSCC). Both conditions may be associated with significant morbidity and constitute a major disease burden, especially among the elderly. To establish an evidence‐based framework for clinical decision making, the guideline “actinic keratosis and cutaneous squamous cell carcinoma” was developed using the highest level of methodology (S3) according to regulations issued by the Association of Scientific Medical Societies in Germany (AWMF). The guideline is aimed at dermatologists, general practitioners, ENT specialists, surgeons, oncologists, radiologists and radiation oncologists in hospitals and office‐based settings as well as other medical specialties involved in the diagnosis and treatment of patients with AK and cSCC. The guideline is also aimed at affected patients, their relatives, policy makers and insurance funds. In the first part, we will address aspects relating to diagnosis, interventions for AK, care structures and quality‐of‐care indicators.

Aktinische Keratosen (AK) sind häufige Hautveränderungen bei hellhäutigen Menschen mit dem Potenzial, in ein kutanes Plattenepithelkarzinom (PEK) überzugehen. Beide Erkrankungen können mit erheblicher Morbidität verbunden sein und stellen eine große Krankheitslast insbesondere in der älteren Bevölkerung dar. Um eine evidenzbasierte, klinische Entscheidungsfindung zu unterstützen, wurde die Leitlinie “Aktinische Keratose und Plattenepithelkarzinom der Haut” auf der Methodikebene S3 nach dem Regelwerk der AWMF entwickelt. Die Leitlinie richtet sich dabei an Dermatologen, Allgemeinmediziner, HNO‐Ärzte, Chirurgen, Onkologen, Radiologen und Strahlentherapeuten in Klinik und Praxis sowie an andere medizinische Fachgebiete, die sich mit der Diagnose und Behandlung von Patienten mit AK und PEK befassen. Die Leitlinie richtet sich auch an betroffene Patienten, deren Angehörige, politische Entscheidungsträger und Versicherungsgesellschaften. In diesem Teil behandeln wir die Themen Diagnostik, Interventionen bei AK, Versorgungsstrukturen und Qualitätsindikatoren.

Aktinische Keratosen (AK) sind haufige Hautveranderungen bei hellhautigen Menschen mit dem Potenzial, in ein kutanes Plattenepithelkarzinom (PEK) uberzugehen. Beide Erkrankungen konnen mit erheblicher Morbiditat verbunden sein und stellen eine grose Krankheitslast insbesondere in der alteren Bevolkerung dar. Um eine evidenzbasierte, klinische Entscheidungsfindung zu unterstutzen, wurde die Leitlinie „Aktinische Keratose und kutanes Plattenepithelkarzinom“ auf der Methodikebene S3 nach dem Regelwerk der AWMF entwickelt. Die Leitlinie richtet sich dabei an Dermatologen, Allgemeinmediziner, HNO-Arzte, Chirurgen, Onkologen, Radiologen und Strahlentherapeuten in Klinik und Praxis sowie an andere medizinische Fachgebiete, die sich mit der Diagnose und Behandlung von Patienten mit AK und PEK befassen. Die Leitlinie richtet sich auch an betroffene Patienten, deren Angehorige, politische Entscheidungstrager und Versicherungsgesellschaften. In diesem Teil behandeln wir die Themen Epidemiologie, Atiologie, chirurgische und systemische Behandlung des PEK, Nachsorge des PEK, Pravention und Berufskrankheit durch AK und PEK.

Basal cell carcinoma is the most common malignant tumor among fair-skinned individuals, and its incidence has been rising steadily in the past decades. In order to maintain the highest quality of patient care possible, the German S2k guidelines were updated following a systematic literature search and with the participation of all professional societies and associations involved in the management of the disease. Part 1 highlights new developments in genetics in particular as well as aspects regarding epidemiology, diagnosis, and histology.

Background Dynamic optical coherence tomography (D-OCT) has recently been introduced in dermatology. In contrast to 'Standard' OCT imaging, which exclusively relies on the morphological analysis of the tissue, D-OCT allows the in vivo visualization of blood flow. Preliminary D-OCT data showed differences in the vascularization of nevus to melanoma transition, suggesting that this technology may help to differentiate between benign and malignant lesions. Objective Several factors may influence the quality of D-OCT imaging. Therefore, standard operating procedures as well as a common terminology are required for better validation and comparison of the images. Methods Here, we present practical guidelines for optimal image acquisition and a proposed terminology on vascular patterns observed by D-OCT. Results Dynamic OCT allows the morphologic distinction of different vascular shapes (e.g. dots, blobs, curves, lines), their distribution and organization within skin lesions. Conclusion D-OCT adds functional information on skin microvasculature and the vascular networks within lesions.

Chronic wounds such as venous leg ulcers invariably heal slowly and recur. In the case of venous leg ulcers, poor healing of chronic wounds is variously attributed to ambulatory hypertension, impaired perfusion and diffusion, presence of chronic inflammation at wound sites, lipodermatosclerosis, and senescence. The aim of this study was to investigate whether a new technique, optical coherence tomography (OCT), which permits imaging of blood capillaries in the peri-wound skin, can provide new insights into the pathology. OCT and its recent variant, dynamic OCT, permit rapid noninvasive depth-resolved imaging of the capillaries in the superficial dermis via a handheld probe, showing the morphology and density of vessels down to 20 µm in diameter. We used dynamic OCT to investigate 15 chronic wounds and assess characteristics of the vessels at the 4 poles around the wounds, the wound bed, adjacent dermatosclerosis, and unaffected skin. The results of the study show that both vessel morphology and density in the wound edges are dramatically different from that in healthy skin, showing clusters of glomuleri-like vessels (knot-like forms or clumps) and an absence of linear branching vessels, and also greater blood perfusion. Such vessel shapes are reported to be associated with tissue growth. The OCT imaging procedure was rapid and well tolerated by patients and provided new information not available from other devices. Thus, OCT appears to have great promise as a tool for the evaluation and study of chronic ulcers.

Actinic keratosis, Bowen disease, and invasive squamous cell carcinoma represent different steps within the disease continuum of squamous neoplasia. Although these stages of squamous neoplasia share common findings, reflectance confocal microscopy may be applied for their differentiation and distinction from other benign or malignant lesions. Hyperkeratosis represents the most important limitation in the evaluation of squamous neoplasia as it may impair the analysis of deeper epidermal and dermal structures significantly.

Thermic injuries are among the most severe injuries in childhood. Burn depth is the most relevant prognostic factor, and still its assessment is both difficult and controversial. This diagnostic uncertainty results in repeated wound assessments over a 10-day period and carries a relevant risk for over- and undertreatment. Precise wound assessment would thus be a significant step toward improved care. Optical coherence tomography (OCT) is a noninvasive laser-based technique with a penetration depth of ∼2 mm. It provides structural images of the skin while dynamic OCT (D-OCT) shows blood vessels. In this study, we investigated burns and scalds in 130 children with OCT and D-OCT to identify patterns of injury related to the depth of the burn wound. OCT and D-OCT images from burned skin differed consistently from normal skin. We observed several not formerly described morphologic patterns associated with burn injuries. Superficial wounds are characterized by a loss of the epidermal layer and a smooth surface. With deeper wounds, surface irregularity, loss of the dermal papillary pattern, disappearance of skin lines, and characteristic changes in the microvascular architecture were observed. This is the first systematic study of D-OCT in the assessment of burn wounds in children. A number of burn-associated patterns of injury were identified. Thus, D-OCT provided an “optical biopsy” of burn wounds that adds significant information about the severity of a burn wound.

BACKGROUND Malignant melanoma is an aggressive skin cancer, which can lead to metastasis development. Vascularization enhancement is fundamental for tumor growth, worsening the prognosis. Dynamic optical coherence tomography (D-OCT) enables the in vivo evaluation of vascular patterns in skin lesions. OBJECTIVE In vivo evaluation of the melanoma vessel morphology by means of D-OCT and correlation with Breslow index. METHODS Retrospective analysis of histologically proven melanomas, evaluated by D-OCT at three different depths (150, 300 and 500 μm), was performed. Vessels were classified according to morphology (dots, blobs, coiled, line, curved, serpiginous), distribution (regular, irregular) and the presence/type of branches. The data were correlated with Breslow thickness. RESULTS A total of 127 melanomas were evaluated. Dotted vessels were recorded at all depths, and their irregular distribution was associated with lesions thicker than 1.0 mm (from 75% to 91%), compared with thin ones (42%) at 150 μm (P = 0.031), and from 33% to 57% vs 18% at 300 μm (P = 0.021). Serpiginous and branching vessels with bulges were predominantly seen in melanomas thicker than 2 mm at 150 μm (from 14% to 27%, P

The subtype of basal cell carcinoma (BCC) influences the choice of treatment. Optical coherence tomography (OCT) is a non-invasive imaging tool, and a recent development of an angiographic version of OCT has extended the application of OCT to image the cutaneous microvasculature (so-called dynamic OCT, D-OCT). This study explores D-OCT's ability to differentiate the common BCC subtypes by microvascular and structural imaging. Eighty-one patients with 98 BCC lesions, consisting of three subtypes: 27 superficial BCC (sBCC), 55 nodular BCC (nBCC) and 16 infiltrative BCC (iBCC) were D-OCT scanned at three European dermatology centres. Blinded evaluations of microvascular and structural features were performed, followed by extensive statistical analysis of risk ratio (RR) and multiple correspondence analysis. nBCC lesions displayed most characteristic structural and vascular features. Serpiginous vessels, branching vessels, vessels creating a circumscribed figure and sharply demarcated hyporeflective ovoid structures in the dermis were all associated with a higher risk of the subtype being nBCC. The presence of highly present lines and dark peripheral borders at the margin of ovoid structures was negatively associated with iBCC. Lastly, the finding of hyporeflective ovoid structures protruding from epidermis correlated with sBCC. We identified various microvascular and structural D-OCT features that may aid non-invasive identification of BCC subtypes. This would allow clinicians to individualize and optimize BCC treatment as well as aid follow-up of non-surgical treatment.

Background/purpose Mohs Micrographic Surgery (MMS) is the preferred therapeutic treatment for high-risk basal cell carcinoma (BCC). Optical Coherence Tomography (OCT) is a non-invasive imaging technique that enables the diagnosis of BCC. We thought to determine the margins of BCCs with OCT, prior to MMS, to reduce the number of surgical steps. Methods Different permanent markers were tested on the skin regarding line width, resistance against disinfection and brightness in the OCT image. The visible tumor margins of BCCs were defined by dermoscopy, adding a safety margin of 2 mm and labeled using the selected pen, causing a signal shadow in OCT. Scans of the center and of entire margin were performed. If parts of the BCC were visible outside the margin, another 2 mm were added and the scan was repeated until the tissue outside the labeling looked tumor free. Results Eight out of ten BCCs were totally excised in a single stage when margin delineation was done by OCT. Macroscopic margins were enlarged after OCT scanning in four patients, saving further stages of MMS. Conclusion OCT may help to better define the microscopic dimensions of BCCs and therefore reduce the number of stages of MMS.

Background A clear distinction between actinic keratosis (AK), Bowen's disease (BD) and squamous cell carcinoma (SCC) cannot reliably be made by clinical and dermoscopic evaluation alone. Dynamic optical coherence tomography (D-OCT) is a novel angiographic variant of OCT that allows for non-invasive, in vivo evaluation of the cutaneous microvascular morphology. Objective To investigate the microvascular structures of AK, BD and invasive SCC using D-OCT in order to gain insights into the microvascular morphology of lesions in the spectrum of keratinocyte skin cancers. Methods Forty-seven patients with a total of 54 lesions (18 AK, 12 BD and 24 SCC) were included in the study. D-OCT still images of AK, BD and SCC at three predefined skin depths were prepared and randomized, creating a study set of 162 D-OCT images. Three observers performed blinded evaluations of the randomized study set assessing multiple parameters including the different types of vascular morphology. Non-blinded quantitative measurements of vascular diameter were also performed. Results The blinded observer analysis suggests that D-OCT evaluation of the vascular morphology may aid in distinguishing AK, BD and SCC lesions. We identified two vascular shapes that presented significantly differently across the lesion types, namely 'blobs' and 'curves'. A strong presence of blobs at 300 μm skin depth was characteristically seen in a third of BD cases, while not or only slightly present in AK and SCC lesions. Vascular curves were predominantly present in AK lesions. Conclusion We identified various vascular D-OCT features that may aid in non-invasively differentiating subtypes within the keratinocyte skin cancer spectrum.

In addition to dermoscopy, there are other imaging and biophysical methods for the noninvasive diagnosis of skin lesions. Confocal laser microscopy allows for high-resolution imaging of the epidermis and upper dermis. It is particularly suitable in the differential diagnosis of melanocytic lesions. Optical coherence tomography (OCT) has a lower resolution compared to confocal laser microscopy but a greater depth of penetration. It is primarily used for imaging epithelial skin cancer, especially in the context of monitoring the effectiveness of nonsurgical therapies. Electrical impedance spectroscopy does not yield cutaneous images but rather provides a score based on the cellular irregularity of the skin. Multispectral analysis involves illumination of the skin with different wavelengths and likewise results in the computation of a score. Both methods are used in the differentiation of dysplastic nevi from melanoma. Other diagnostic imaging and biophysical methods are currently still in the developmental stages. By increasing the sensitivity and specificity of clinical and dermoscopic findings, the aforementioned methods bring about an improvement in noninvasive diagnosis. They allow for skin lesions to be monitored over time and therapeutic effects to be quantified. Finally, they facilitate early diagnosis of skin cancer, and help avoid unnecessary surgery of benign lesions.