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Basal epidermal keratinocyte atypia (AK I) and proliferation (PRO score) seem to drive malignant transformation, rather than clinical appearance of AK (Olsen I\u2013III). Due to the invasiveness of punch biopsy, those histological criteria are not regularly assessed. Non\u2010invasive imaging techniques, such as optical coherence tomography (OCT), reflectance confocal microscopy (RCM) and line\u2010field confocal OCT (LC\u2010OCT) are helpful to distinguish complex cases of AK, Bowen's disease, and SCC. Moreover, LC\u2010OCT can visualize the epidermis and the papillary dermis at cellular resolution, allowing real\u2010time PRO score assessment. The decision\u2010making for implementation of therapy is still based on clinical risk factors, ranging from lesion\u2010 to field\u2010targeted and ablative to non\u2010ablative regimens, but in approximately 85% of the cases a recurrence of AK can be observed after a 1\u2010year follow\u2010up. The possible beneficial use of imaging techniques for a non\u2010invasive follow\u2010up of AK to detect recurrence or invasive progression early on should be subject to critical evaluation in further studies.<\/jats:p>","DOI":"10.1111\/ddg.15288","type":"journal-article","created":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T05:49:24Z","timestamp":1709876964000},"page":"675-690","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Diagnosis and therapy of actinic keratosis"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6205-7959","authenticated-orcid":false,"given":"Janis Raphael","family":"Thamm","sequence":"first","affiliation":[{"name":"Department of Dermatology and Allergology University Hospital Augsburg  Augsburg 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