Dermatoscopic methods for diagnosing radiation-induced skin reactions in patients with primary cutaneous lymphomas undergoing total skin electron beam therapy

Background: Timely diagnosis and assessment of radiation-induced skin reactions remain an important challenge in modern medicine. Imaging techniques can help standardize the clinical evaluation of radiation dermatitis. Aim: The work aimed to evaluate dermatoscopic features and confocal microscopy findings in radiation dermatitis among patients with primary cutaneous lymphomas undergoing radiotherapy, with subsequent analysis of the clinical and morphological characteristics of affected skin areas before treatment and at cumulative doses of 6 Gy, 14 Gy, and 30 Gy, based on macroscopic and dermatoscopic imaging of radiation-induced skin reactions for further comparison. Methods: Data from 40 patients at the Granov Russian Scientific Center for Radiology and Surgical Technologies receiving electron beam radiotherapy for primary cutaneous lymphomas were analyzed. As clinical symptoms of radiation-induced skin reactions developed, morphological changes in the affected areas were examined. Dermatoscopic evaluation of skin lesions was performed using a HYPERLINK "https://shop.heine-med.ru/catalog/dermatoskopy/?ysclid=m63jpoace3558532091"Heine Optotechnik (Germany) dermatoscope at tenfold magnification. Confocal spectroscopy was conducted using the VivaScope® 1500 medical device (MAVIG GmbH, Munich, Germany). Instrumental data underwent correlation analysis to identify statistical relationships between dermatoscopic parameters and the severity of radiation-induced skin reactions. Results: Dermatoscopy revealed patterns characteristic of different stages of radiation-induced skin reactions: reticular vascular arrangements in the dermis, brown scaly elements, perifollicular pigmentation, and follicular plugs arranged in rosette-like patterns. Confocal microscopy of radiation dermatitis lesions identified non-stochastic skin changes, including exocytosis (55.3%), spongiosis (63.5%), disorganization of the epidermis (65%), and abnormally structured dermal papillae (85.4%). Low-contrast microvascular cells marking vascular dysfunction in the dermal vascular bed were a specific feature of radiation dermatitis observed regardless of severity. Conclusion: Accurate assessment of skin damage severity can help optimize the management of patients undergoing radiotherapy for primary cutaneous lymphomas. These findings are promising for integrating instrumental evaluation methods into routine clinical practice for early detection of radiation-induced skin changes and predicting disease severity.