Could an intra-procedural dermoscopic approach be necessary for obtaining radical treatment of actinic keratosis cancerization field if combined with ablative CO₂ laser?

Actinic keratosis (AK) is a common skin disorder resulting from chronic sun exposure, which can be treated with various treatment modalities, including ablative CO2 laser. Dermoscopic evaluation is fundamental in diagnosis and post-procedural follow-up. This study aimed to achieve radical clearance of AK cancerization fields through a combined approach using an ablative CO2 laser and intra-procedural dermoscopy, rather than a pre- and post-procedural approach only. Twenty patients with 25 AKs were included in the study. Treatment with ablative CO2 laser through a dermoscopic intra-procedural approach was performed for every patient with Olsen grade I or II AK. The results of this study showed that 100% of patients treated with this method achieved clinical clearance at follow-up, and 92% had no clinical recurrence after 2 months. The intra-procedural dermoscopic approach demonstrated to be useful to extend laser ablation to the AK cancerization field. According to the results of our study and after a comprehensive literature review, we conclude that intra-procedural dermatoscopy combined with ablative CO2 laser therapy can be considered a valid alternative to CO2 laser therapy alone.