1
|
Malvehy J, Stratigos AJ, Bagot M, Stockfleth E, Ezzedine K, Delarue A. Actinic keratosis: Current challenges and unanswered questions. J Eur Acad Dermatol Venereol 2024; 38 Suppl 5:3-11. [PMID: 38923589 DOI: 10.1111/jdv.19559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 09/29/2023] [Indexed: 06/28/2024]
Abstract
Actinic keratoses (AK) are common skin lesions associated with chronic exposure to sun. They are believed to be precursors of malignancy as they potentially may progress to invasive squamous cell carcinomas. The goal of current therapies is to reduce the number of AK and to prevent future cancer development. This review aims at providing an overview of the hallmarks of AK and skin field cancerization. We discuss epidemiology trends, risk factors and the state of the art and evidence of the current treatments. We review key figures of AK prevalence from different countries with regard to skin cancer risk and the associated economic burden of AK. We discuss the mutational status in AK lesions and the difficulties encountered by clinicians in evaluating AK visible and invisible lesions, referring to the concept of field cancerization. Based on a systematic literature review, we further evaluate the available treatment options. The presence of subclinical skin alterations in the periphery of visible AK lesions has gained a particular attention as those non-visible lesions are known to contain the same genetic changes as those found in the AK lesions themselves, prompting the concept of 'field cancerization'. Therefore, AK treatment guidelines now recognize the importance of treating the field in patients with AK. A recent systematic literature review and network meta-analysis showed that 5-FU interventions were associated with the best efficacy and a satisfactory acceptability profile compared with other field-directed therapies used in the treatment of AK. Although AK are considered quite common, they lack an accurate descriptive definition and conclusive epidemiologic data. Limited public awareness is a barrier to early and effective treatment, including prevention strategies. While different treatment options are available, there is still a limited understanding of long-term outcomes of treatment as measured by recurrence of cancer prevention.
Collapse
Affiliation(s)
- Josep Malvehy
- Hospital Clinic de Barcelona, IDIBAPS, and Spain & Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Universitat de Barcelona, Barcelona, Spain
| | | | - Martine Bagot
- Department of Dermatology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, and Human Immunology, Pathophysiology and Immunotherapy, Institut National de la Santé et de la Recherche Médicale U976, Université de Paris, Paris, France
| | - Eggert Stockfleth
- Department of Dermatology, Ruhr University of Bochum, Bochum, Germany
| | - Khaled Ezzedine
- Department of Dermatology, Hôpital Henri Mondor, EA EpiDermE, UPEC-Université Paris-Est Créteil, Créteil, France
| | | |
Collapse
|
2
|
Schlesinger T, Stockfleth E, Grada A, Berman B. Tirbanibulin for Actinic Keratosis: Insights into the Mechanism of Action. Clin Cosmet Investig Dermatol 2022; 15:2495-2506. [PMID: 36415541 PMCID: PMC9675993 DOI: 10.2147/ccid.s374122] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/19/2022] [Indexed: 08/13/2023]
Abstract
Actinic keratosis (AK) is a common pre-neoplastic skin lesion constituted by uncontrolled proliferation of atypical keratinocytes that may evolve to squamous cell carcinoma. With global prevalence increasing, AK is expected to be the most common carcinoma of the skin. Tirbanibulin is a reversible tubulin polymerization inhibitor with potent anti-proliferative and anti-tumoral effects. In-vivo and in-vitro studies have shown that tirbanibulin significantly inhibits cell proliferation, tumor growth and downregulates Src signaling with no overt toxicity. Early phase and Phase III trials have shown high lesion clearance, compliance, and few side effects of once daily tirbanibulin treatment. This review discusses tirbanibulin anti-cancer activity, focusing on tubulin polymerization and Src signaling inhibitory effects, highlighting relevant literature and novel preclinical results from the ATNXUS-KX01-001 study. Furthermore, we address the relevant findings obtained in recent clinical trials to evaluate the safety, efficacy, pharmacokinetics, clearance efficacy, and side effects of the 1% tirbanibulin ointment applied once daily. In summary, we highlight preclinical and clinical evidence on the use of tirbanibulin as an effective and safe treatment option for AK.
Collapse
Affiliation(s)
| | - Eggert Stockfleth
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Ayman Grada
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Brian Berman
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
3
|
Del Regno L, Catapano S, Di Stefani A, Cappilli S, Peris K. A Review of Existing Therapies for Actinic Keratosis: Current Status and Future Directions. Am J Clin Dermatol 2022; 23:339-352. [PMID: 35182332 PMCID: PMC9142445 DOI: 10.1007/s40257-022-00674-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 01/17/2023]
Abstract
Actinic keratosis (AK) is a chronic skin disease in which clinical and subclinical cutaneous lesions coexist on sun-exposed areas such as the head and neck region and the extremities. The high prevalence of AK means the disease burden is substantial, especially in middle-aged and elderly populations. Evidence indicates that AK may progress into invasive cutaneous squamous cell carcinoma, so the European guidelines recommend treatment of any AK regardless of clinical severity. Given the aging population and therefore the increasing incidence of AK and cutaneous field carcinogenesis, further updates on the long-term efficacy of current therapies and new investigational agents are critical to guide treatment choice. Patients often have difficulty adequately applying topical treatments and coping with adverse local skin reactions, leading to less than optimum treatment adherence. The development of associated local skin symptoms and cosmetic outcomes for the area of interest are also relevant to the choice of an appropriate therapeutic strategy. Treatment is always individually tailored according to the characteristics of both patients and lesions. This review focuses on the therapeutic approaches to AK and illustrates the currently available home-based and physician-managed treatments.
Collapse
|
4
|
Ahmady S, Jansen MHE, Nelemans PJ, Kessels JPHM, Arits AHMM, de Rooij MJM, Essers BAB, Quaedvlieg PJF, Kelleners-Smeets NWJ, Mosterd K. Risk of Invasive Cutaneous Squamous Cell Carcinoma After Different Treatments for Actinic Keratosis: A Secondary Analysis of a Randomized Clinical Trial. JAMA Dermatol 2022; 158:634-640. [PMID: 35475852 PMCID: PMC9047727 DOI: 10.1001/jamadermatol.2022.1034] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Treatment of actinic keratosis (AK) aims to prevent cutaneous squamous cell carcinoma (cSCC). However, whether AK can progress into invasive cSCC is a matter of debate, and little is known about the effect of treatment on preventing cSCC. Objectives To evaluate the risk of invasive cSCC and factors that may contribute to increased risk in patients with multiple AKs. Design, Setting, and Participants In this secondary analysis of a multicenter randomized clinical trial, 624 patients with a minimum of 5 AKs within an area of 25 to 100 cm2 on the head were recruited from the Department of Dermatology of 4 hospitals in the Netherlands. Long-term follow-up was performed from July 1, 2019, to December 31, 2020. Interventions Patients were randomized to treatment with 5% fluorouracil, 5% imiquimod cream, methylaminolevulinate photodynamic therapy, or 0.015% ingenol mebutate gel. Main Outcomes and Measures The primary outcome was the proportion of patients with invasive cSCC in the target area during follow-up. Secondary outcomes were the associations between risk of invasive cSCC and a priori defined potential prognostic factors, including type of treatment, severity of AK (Olsen grade), history of nonmelanoma skin cancer, and additional treatment. Results Of the 624 patients (558 [89.4%] male; median age, 73 years [range, 48-94 years]) in the study, 26 were diagnosed with a histologically proven invasive cSCC in the target area during follow-up. The total 4-year risk of developing cSCC in a previously treated area of AK was 3.7% (95% CI, 2.4%-5.7%), varying from 2.2% (95% CI, 0.7%-6.6%) in patients treated with fluorouracil to 5.8% (95% CI, 2.9%-11.3%) in patients treated with imiquimod. In patients with severe AK (Olsen grade III), the risk was 20.9% (95% CI, 10.8%-38.1%), and the risk was especially high (33.5%; 95% CI, 18.2%-56.3%) in patients with severe AK who needed additional treatment. Conclusions and Relevance In this secondary analysis of a randomized clinical trial, risk of invasive cSCC was highest in patients with Olsen grade III AK and was substantially increased in patients who received additional treatment. These patients should be closely followed up after treatment. Trial Registration ClinicalTrials.gov Identifier: NCT02281682.
Collapse
Affiliation(s)
- Shima Ahmady
- Department of Dermatology, Maastricht University Medical Center, Maastricht, the Netherlands.,GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Maud H E Jansen
- Department of Dermatology, Maastricht University Medical Center, Maastricht, the Netherlands.,GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Patty J Nelemans
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | | | - Aimee H M M Arits
- Department of Dermatology, Maastricht University Medical Center, Maastricht, the Netherlands.,GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Dermatology, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Brigitte A B Essers
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Nicole W J Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Center, Maastricht, the Netherlands.,GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Klara Mosterd
- Department of Dermatology, Maastricht University Medical Center, Maastricht, the Netherlands.,GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| |
Collapse
|
5
|
Arisi M, Guasco Pisani E, Calzavara-Pinton P, Zane C. Cryotherapy for Actinic Keratosis: Basic Principles and Literature Review. Clin Cosmet Investig Dermatol 2022; 15:357-365. [PMID: 35283641 PMCID: PMC8906699 DOI: 10.2147/ccid.s267190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/22/2022] [Indexed: 11/25/2022]
Abstract
Actinic keratoses (AKs) are pre-malignant epithelial lesions induced by chronic cumulative UV exposure. Several guidelines concerning AKs treatment have been published in the past years. Among destructive procedures, cryotherapy is today considered a standard first-line approach in case of single lesions. The aim of the present review article is to analyse the treatment technique, its efficacy and safety.
Collapse
Affiliation(s)
- Mariachiara Arisi
- Department of Dermatology, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Edoardo Guasco Pisani
- Department of Dermatology, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Cristina Zane
- Department of Dermatology, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| |
Collapse
|
6
|
Xu D, Sun JF, Qi RQ, Zhang W, Dong LD, Liu TY, Zheng S, Niu RX, Zhang J, Cui TT, He L, Chen HD. A multicenter retrospective analysis of the clinical and pathological characteristics of 1188 cases of actinic keratosis in different ultraviolet radiation intensity areas of China. J Cosmet Dermatol 2021; 21:2879-2888. [PMID: 34719097 DOI: 10.1111/jocd.14479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 08/29/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Actinic keratosis (AK) is a precancerous disease, caused by ultraviolet radiation (UV). OBJECTIVE To analyze the clinical and pathological characteristics of AK in four areas with different ultraviolet radiation intensities. METHODS 1188 diagnosed AK patients, from January 2000 to July 2015, in dermatology department of four hospitals were collected. The UV intensity of hospital located cities from high to low is Kunming, Yinchuan, Shenyang and Nanjing. The information comes from medical records, and the pathological types and Keratinocyte Intraepithelial Neoplasia (KIN) grades were checked by two experienced pathologists. All information was conducted a retrospective multicenter research. RESULTS The patients were mainly middle-aged and elderly female, which was in direct contrast to the majority of men in European. The age of onset in Kunming group was lower than that in Yinchuan Group (p = 0.013) and Nanjing Group (p < 0.01). The course of disease in Kunming group was significantly shorter than that in Nanjing Group (p < 0.001). The lesions were almost located in the exposed area. The proportion of unexposed areas in Shenyang group was significantly higher than that in other groups (p < 0.001). There were statistical differences in pathological morphological classification among the four groups. These differences were not affected by age and gender. The number of KIN III grade patients in Shenyang group was significantly higher than that in other three groups (p < 0.05). CONCLUSION The Asian patients were mainly female. The clinical characteristics of AK are closely related to UV intensity, and environmental pollution, lifestyle, religious beliefs and other factors are also related.
Collapse
Affiliation(s)
- Dan Xu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jian-Fang Sun
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Rui-Qun Qi
- Department of Dermatology, Key Laboratory of Immunodermatology of NHC and Ministry of Education, The First Hospital of China Medical University, Shenyang, China
| | - Wei Zhang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Ling-Di Dong
- Department of Dermatology, General Hospital of Ningxia Medical University, Ningxia, China
| | - Tong-Yun Liu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Song Zheng
- Department of Dermatology, Key Laboratory of Immunodermatology of NHC and Ministry of Education, The First Hospital of China Medical University, Shenyang, China
| | - Rui-Xian Niu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Juan Zhang
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ting-Ting Cui
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Li He
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hong-Duo Chen
- Department of Dermatology, Key Laboratory of Immunodermatology of NHC and Ministry of Education, The First Hospital of China Medical University, Shenyang, China
| |
Collapse
|
7
|
Ruini C, Schuh S, Gust C, Hartmann D, French LE, Sattler EC, Welzel J. In-Vivo LC-OCT Evaluation of the Downward Proliferation Pattern of Keratinocytes in Actinic Keratosis in Comparison with Histology: First Impressions from a Pilot Study. Cancers (Basel) 2021; 13:2856. [PMID: 34201052 PMCID: PMC8228287 DOI: 10.3390/cancers13122856] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/21/2022] Open
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.
Collapse
Affiliation(s)
- Cristel Ruini
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
- PhD School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Sandra Schuh
- Department of Dermatology and Allergy, University Hospital, 86156 Augsburg, Germany;
| | - Charlotte Gust
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
| | - Lars Einar French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL 33125, USA
| | - Elke Christina Sattler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
| | - Julia Welzel
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
| |
Collapse
|
8
|
Sinclair R, Baker C, Spelman L, Supranowicz M, MacMahon B. A review of actinic keratosis, skin field cancerisation and the efficacy of topical therapies. Australas J Dermatol 2020; 62:119-123. [PMID: 32840870 PMCID: PMC8247342 DOI: 10.1111/ajd.13447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/16/2020] [Accepted: 07/26/2020] [Indexed: 12/14/2022]
Abstract
While a wide range of treatments exist for actinic keratosis and skin field cancerisation, the long‐term benefits of the most common topical therapies are poorly defined. This report reviews the efficacy of the most commonly used topical therapies to treat regional or field lesions. Limited clinical and histopathological data are available on clearance rates at 12 months post‐treatment for the most commonly used agents, with varied outcome measures making any comparison difficult. In general, total field clearance rates at 12 months are suboptimal for the most commonly employed agents. Given the increasing incidence of actinic keratosis and skin field cancerisation due to an ageing population, further research into the efficacy of therapies is critical to guide treatment choice.
Collapse
Affiliation(s)
- Robert Sinclair
- Specialist Connect Services, Brisbane, Queensland, Australia
| | | | - Lynda Spelman
- Specialist Connect Services, Brisbane, Queensland, Australia
| | | | - Beth MacMahon
- Specialist Connect Services, Brisbane, Queensland, Australia
| |
Collapse
|
9
|
Cramer P, Stockfleth E. Actinic keratosis: where do we stand and where is the future going to take us? Expert Opin Emerg Drugs 2020; 25:49-58. [PMID: 32067498 DOI: 10.1080/14728214.2020.1730810] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Actinic keratosis (AK) is a chronic disease which is mainly located across areas of sun-exposed skin. Clinical and subclinical lesions coexist across a large area resulting in a field cancerization. As these lesions have the potential to transform into invasive squamous cell carcinoma (iSCC), treatment is crucial. With global prevalence increasing, AK is expected to be the most common in situ carcinoma of the skin.Areas covered: In this article, we cover the established algorithm of treating AK and give an insight into the drugs under development. There are six compounds under development covering different treatment angles, from Sinecatechin a Polyphenon E which targets the link between HPV infection and development of AK, over Tirbanibulin which targets the SRC proto-oncogene and fast proliferating cells, to Tuvatexib a small-molecule dual VDAC/HK2 modulator that has shown that it can compete with the established therapies.Expert opinion: These new treatment options are moving us further toward a more individually tailored treatment for each patient considering his abilities, the size and location of his lesions but also the genetic bases as well as individual risk of transforming into a iSCC and possibly other factors contributing to each patients individual AK lesions.
Collapse
Affiliation(s)
- Philipp Cramer
- St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Bochum, Germany
| | - Eggert Stockfleth
- St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Bochum, Germany
| |
Collapse
|
10
|
Veronese F, Zavattaro E, Orioni G, Landucci G, Tarantino V, Airoldi C, Savoia P. Efficacy of new class I medical device for actinic keratoses: a randomized controlled prospective study. J DERMATOL TREAT 2019; 32:625-630. [PMID: 31689138 DOI: 10.1080/09546634.2019.1687820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The presence of Actinic Keratoses (AKs) represent the most important warning sign of subclinical ultraviolet radiation. Currently, the regular use of sunscreens is considered essential for the prevention of the development of AKs. AIM We evaluated the effectiveness of a new class I Medical Device (MD) for the prevention and treatment of AKs vs traditional sunscreen alone (SPF 100+). METHODS We conducted a randomized controlled prospective study in 90 Caucasian patients: 62 immunocompetent and 28 Organ Transplant Recipients (OTRs). We randomly assigned subjects to the MD group or sunscreen alone in a 1:1 assignment ratio. The patients have been reevaluated after three and six months. RESULTS In immunocompetent patients treated with MD, at the end of the study the reduction of the mean number of AKs was 54.7 vs. 9.43% with photoprotector. In OTRs, the global reduction was of 36.7% after MD use compared to 14.3% with the sunscreen. The prevalence of NMSCs, in the patients treated with MD, was 11.11 and 17.18 with sunscreen; the incidence was 19.7 in patients treated with MD and 32.1 in those treated with sunscreen. CONCLUSION The MD has demonstrated good efficacy in the reduction of visible AKs, encouraging its use also in high-risk category, like OTRs.
Collapse
Affiliation(s)
- Federica Veronese
- Department of Health Science, Dermatologic Clinic, University of Eastern Piedmont, Novara, Italy
| | - Elisa Zavattaro
- Department of Translational Medicine, Dermatologic Clinic, University of Eastern Piedmont, Novara, Italy
| | - Gionathan Orioni
- Department of Health Science, Dermatologic Clinic, University of Eastern Piedmont, Novara, Italy
| | - Gianluca Landucci
- Department of Health Science, Dermatologic Clinic, University of Eastern Piedmont, Novara, Italy
| | - Vanessa Tarantino
- Department of Health Science, Dermatologic Clinic, University of Eastern Piedmont, Novara, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, Università Del Piemonte Orientale, Novara, Italy
| | - Paola Savoia
- Department of Health Science, Dermatologic Clinic, University of Eastern Piedmont, Novara, Italy
| |
Collapse
|
11
|
Bakshi A, Shafi R, Nelson J, Cantrell WC, Subhadarshani S, Andea A, Athar M, Elmets CA. The clinical course of actinic keratosis correlates with underlying molecular mechanisms. Br J Dermatol 2019; 182:995-1002. [PMID: 31299087 DOI: 10.1111/bjd.18338] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Actinic keratoses (AKs) are common premalignant skin lesions triggered by excessive ultraviolet exposure. The majority of AKs regress or persist, but some progress to squamous cell carcinomas. Biomarkers associated with their persistence, progression and regression have not been characterized. OBJECTIVES We performed skin biopsies in patients with extensive actinic damage to identify biomarkers that correlate with clinical progression and regression of AKs. METHODS This was an observational study of a cohort of patients with extensive actinic damage. AKs were mapped on a clear plastic template in 26 patients at months 3, 6, 9 and 11. Biopsies were taken from randomly selected, predetermined AKs and were evaluated for p53, E-cadherin, Snail, Slug and Twist. The study is registered at Clinicaltrials.gov: NCT00027976. RESULTS p53 exhibited greater expression in clinically apparent AKs (histological score 2·89 ± 1·45) than in regressed AKs (0·75 ± 0·96); P < 0·01. There was also significantly less membrane E-cadherin, the lack of which is a marker of epithelial-mesenchymal transition, in clinically apparent AKs (1·89 ± 1·81) than in sun-exposed skin (3·07 ± 1·75); P < 0·005. The E-cadherin transcription repressors Snail, Slug and Twist were increased in AKs compared with sun-exposed skin. A limitation of the study is that measurement of histological biomarkers was not a primary end point. In addition, patients were allowed to apply sunscreens. CONCLUSIONS At the molecular level, loss of E-cadherin and an increase in p53 are linked to the dynamic interplay between the persistence, progression and regression of AKs. What's already known about this topic? Actinic keratoses (AKs) are common dysplastic epidermal lesions that result from chronic and excessive ultraviolet exposure. Biomarkers associated with progression and regression of AK have not been characterized. What does this study add? Decreased E-cadherin and increased p53, Snail, Slug and Twist (E-cadherin transcription factors) were associated with progression from AK to nonmelanoma skin cancer. What is the translational message? Strategies targeting these molecules may be effective in reversing rising skin cancer rates. E-cadherin, p53, Snail, Slug and Twist are potential biomarkers that may be used to assess the efficacy of existing chemopreventive agents.
Collapse
Affiliation(s)
- A Bakshi
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, U.S.A.,Rutgers New Jersey Medical School, New Brunswick, NJ, U.S.A
| | - R Shafi
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, U.S.A
| | - J Nelson
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, U.S.A
| | - W C Cantrell
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, U.S.A
| | - S Subhadarshani
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, U.S.A
| | - A Andea
- Department of Pathology, University of Michigan, Ann Arbor, MI, U.S.A
| | - M Athar
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, U.S.A.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, U.S.A
| | - C A Elmets
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, U.S.A.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, U.S.A.,Birmingham VA Medical Center, Birmingham, AL, U.S.A
| |
Collapse
|
12
|
Heerfordt I, Wulf H. Daylight photodynamic therapy of actinic keratosis without curettage is as effective as with curettage: a randomized clinical trial. J Eur Acad Dermatol Venereol 2019; 33:2058-2061. [DOI: 10.1111/jdv.15744] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/29/2019] [Indexed: 12/31/2022]
Affiliation(s)
- I.M. Heerfordt
- Department of Dermatology, Bispebjerg Hospital University of Copenhagen Copenhagen Denmark
| | - H.C. Wulf
- Department of Dermatology, Bispebjerg Hospital University of Copenhagen Copenhagen Denmark
| |
Collapse
|
13
|
Ruini C, Hartmann D, Bastian M, Ruzicka T, French LE, Berking C, von Braunmühl T. Non-invasive monitoring of subclinical and clinical actinic keratosis of face and scalp under topical treatment with ingenol mebutate gel 150 mcg/g by means of reflectance confocal microscopy and optical coherence tomography: New perspectives and comparison of diagnostic techniques. JOURNAL OF BIOPHOTONICS 2019; 12:e201800391. [PMID: 30653833 DOI: 10.1002/jbio.201800391] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/12/2019] [Accepted: 01/13/2019] [Indexed: 06/09/2023]
Abstract
Actinic keratosis (AK) corresponds to the earliest stage of in situ squamous cell carcinoma and arises on chronically sun-exposed skin. Around the clinically evident AKs, the apparently healthy epidermis may contain different grades of atypia that can be detected by noninvasive imaging techniques such as reflectance confocal microscopy (RCM) and optical coherence tomography (OCT). Subclinical actinic keratosis (sAK) has captured increasing interest as a potential target of field therapies. The aim of this study was to evaluate in vivo the changes in the field cancerization undergoing treatment with topical ingenol mebutate by combining RCM and OCT. Twenty patients with field cancerization of the face and scalp were treated with ingenol mebutate gel (150 mcg/g) for three consecutive days on an area of 25 cm2 containing at least two AKs, two sAKs and two apparently healthy sites. About 120 lesions were evaluated through clinical investigation and clinical, dermoscopical, RCM and OCT images at day 0, 4, 14 and 56 based on the diagnostic criteria for AKs. Main pathological features improved in both AKs and sAKs, in particular the epidermal thickness measured by OCT and the epidermal atypia graded by RCM. Local skin reactions (LSR) arose predominantly in the lesional area compared with healthy skin. A complete clearance was detected in 58% for AKs, and in 55% and 72% for sAKs measured by RCM and OCT, respectively. Both OCT and RCM allow the morphological representation of field cancerization including subclinical lesions and provide complementary information. Ingenol mebutate is effective not only in clinically evident but also in sAKs. The differences in LSR highlight the potential selectivity of the treatment.
Collapse
Affiliation(s)
- Cristel Ruini
- Department of Dermatology and Allergy, University Hospital LMU Munich, Munich, Germany
- Department of Dermatology, Clinic for Dermatology and Allergy, Munich Municipal Hospital Group, Munich, Germany
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital LMU Munich, Munich, Germany
- Department of Dermatology, Clinic for Dermatology and Allergy, Munich Municipal Hospital Group, Munich, Germany
| | - Mike Bastian
- Medical Advisory Department, LEO Pharma GmbH, Neu-Isenburg, Germany
| | - Thomas Ruzicka
- Department of Dermatology and Allergy, University Hospital LMU Munich, Munich, Germany
| | - Lars E French
- Department of Dermatology and Allergy, University Hospital LMU Munich, Munich, Germany
| | - Carola Berking
- Department of Dermatology and Allergy, University Hospital LMU Munich, Munich, Germany
| | - Tanja von Braunmühl
- Department of Dermatology and Allergy, University Hospital LMU Munich, Munich, Germany
- Department of Dermatology, Clinic for Dermatology and Allergy, Munich Municipal Hospital Group, Munich, Germany
| |
Collapse
|
14
|
Review of Clinical Evidence over 10 Years on Prevention and Treatment of a Film-Forming Medical Device Containing Photolyase in the Management of Field Cancerization in Actinic Keratosis. Dermatol Ther (Heidelb) 2019; 9:259-270. [PMID: 30968311 PMCID: PMC6522584 DOI: 10.1007/s13555-019-0294-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Indexed: 02/08/2023] Open
Abstract
Abstract Actinic keratosis (AK) is a common pathology that afflicts sun-exposed areas of the skin. It predominantly affects older and fair-skinned individuals suggesting an accumulative damage attributable to chronic sun exposure. The prevalence of AK has risen in the past decades and is expected to continue to rise. Apart from visible hyperkeratotic, hyperplastic lesions, AK is also associated with the presence of subclinical lesions adjacent to tumor tissue, which has led to the use of the concept “cancerization field”. Although lesion- and field-targeting treatments are currently available, many are associated with local side effects and recurrence of new lesions. This review provides information on AK pathophysiology and treatment options and summarizes the available clinical evidence supporting the use of Eryfotona AK-NMSC, a film-forming medical device with SPF 100+ containing the DNA repair enzyme photolyase, for managing AK, based on the analysis of the results of 228 patients treated with the product. Funding ISDIN funded the Article Processing Charges. Electronic supplementary material The online version of this article (10.1007/s13555-019-0294-1) contains supplementary material, which is available to authorized users.
Collapse
|
15
|
Jansen MHE, Kessels JPHM, Nelemans PJ, Kouloubis N, Arits AHMM, van Pelt HPA, Quaedvlieg PJF, Essers BAB, Steijlen PM, Kelleners-Smeets NWJ, Mosterd K. Randomized Trial of Four Treatment Approaches for Actinic Keratosis. N Engl J Med 2019; 380:935-946. [PMID: 30855743 DOI: 10.1056/nejmoa1811850] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Actinic keratosis is the most frequent premalignant skin disease in the white population. In current guidelines, no clear recommendations are made about which treatment is preferred. METHODS We investigated the effectiveness of four frequently used field-directed treatments (for multiple lesions in a continuous area). Patients with a clinical diagnosis of five or more actinic keratosis lesions on the head, involving one continuous area of 25 to 100 cm2, were enrolled at four Dutch hospitals. Patients were randomly assigned to treatment with 5% fluorouracil cream, 5% imiquimod cream, methyl aminolevulinate photodynamic therapy (MAL-PDT), or 0.015% ingenol mebutate gel. The primary outcome was the proportion of patients with a reduction of 75% or more in the number of actinic keratosis lesions from baseline to 12 months after the end of treatment. Both a modified intention-to-treat analysis and a per-protocol analysis were performed. RESULTS A total of 624 patients were included from November 2014 through March 2017. At 12 months after the end of treatment, the cumulative probability of remaining free from treatment failure was significantly higher among patients who received fluorouracil (74.7%; 95% confidence interval [CI], 66.8 to 81.0) than among those who received imiquimod (53.9%; 95% CI, 45.4 to 61.6), MAL-PDT (37.7%; 95% CI, 30.0 to 45.3), or ingenol mebutate (28.9%; 95% CI, 21.8 to 36.3). As compared with fluorouracil, the hazard ratio for treatment failure was 2.03 (95% CI, 1.36 to 3.04) with imiquimod, 2.73 (95% CI, 1.87 to 3.99) with MAL-PDT, and 3.33 (95% CI, 2.29 to 4.85) with ingenol mebutate (P≤0.001 for all comparisons). No unexpected toxic effects were documented. CONCLUSIONS At 12 months after the end of treatment in patients with multiple actinic keratosis lesions on the head, 5% fluorouracil cream was the most effective of four field-directed treatments. (Funded by the Netherlands Organization for Health Research and Development; ClinicalTrials.gov number, NCT02281682.).
Collapse
Affiliation(s)
- Maud H E Jansen
- From the Departments of Dermatology (M.H.E.J., J.P.H.M.K., N.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and Clinical Epidemiology and Medical Technology Assessment (B.A.B.E.), Maastricht University Medical Center, and the GROW School for Oncology and Developmental Biology (M.H.E.J., J.P.H.M.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and the Department of Epidemiology (P.J.N.), Maastricht University, Maastricht, the Department of Dermatology, Zuyderland Medical Center, Heerlen (J.P.H.M.K., P.J.F.Q.), the Department of Dermatology, Catharina Hospital, Eindhoven (A.H.M.M.A., P.M.S.), and the Department of Dermatology, VieCuri Medical Center, Venlo (H.P.A.P.) - all in the Netherlands
| | - Janneke P H M Kessels
- From the Departments of Dermatology (M.H.E.J., J.P.H.M.K., N.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and Clinical Epidemiology and Medical Technology Assessment (B.A.B.E.), Maastricht University Medical Center, and the GROW School for Oncology and Developmental Biology (M.H.E.J., J.P.H.M.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and the Department of Epidemiology (P.J.N.), Maastricht University, Maastricht, the Department of Dermatology, Zuyderland Medical Center, Heerlen (J.P.H.M.K., P.J.F.Q.), the Department of Dermatology, Catharina Hospital, Eindhoven (A.H.M.M.A., P.M.S.), and the Department of Dermatology, VieCuri Medical Center, Venlo (H.P.A.P.) - all in the Netherlands
| | - Patty J Nelemans
- From the Departments of Dermatology (M.H.E.J., J.P.H.M.K., N.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and Clinical Epidemiology and Medical Technology Assessment (B.A.B.E.), Maastricht University Medical Center, and the GROW School for Oncology and Developmental Biology (M.H.E.J., J.P.H.M.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and the Department of Epidemiology (P.J.N.), Maastricht University, Maastricht, the Department of Dermatology, Zuyderland Medical Center, Heerlen (J.P.H.M.K., P.J.F.Q.), the Department of Dermatology, Catharina Hospital, Eindhoven (A.H.M.M.A., P.M.S.), and the Department of Dermatology, VieCuri Medical Center, Venlo (H.P.A.P.) - all in the Netherlands
| | - Nina Kouloubis
- From the Departments of Dermatology (M.H.E.J., J.P.H.M.K., N.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and Clinical Epidemiology and Medical Technology Assessment (B.A.B.E.), Maastricht University Medical Center, and the GROW School for Oncology and Developmental Biology (M.H.E.J., J.P.H.M.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and the Department of Epidemiology (P.J.N.), Maastricht University, Maastricht, the Department of Dermatology, Zuyderland Medical Center, Heerlen (J.P.H.M.K., P.J.F.Q.), the Department of Dermatology, Catharina Hospital, Eindhoven (A.H.M.M.A., P.M.S.), and the Department of Dermatology, VieCuri Medical Center, Venlo (H.P.A.P.) - all in the Netherlands
| | - Aimee H M M Arits
- From the Departments of Dermatology (M.H.E.J., J.P.H.M.K., N.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and Clinical Epidemiology and Medical Technology Assessment (B.A.B.E.), Maastricht University Medical Center, and the GROW School for Oncology and Developmental Biology (M.H.E.J., J.P.H.M.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and the Department of Epidemiology (P.J.N.), Maastricht University, Maastricht, the Department of Dermatology, Zuyderland Medical Center, Heerlen (J.P.H.M.K., P.J.F.Q.), the Department of Dermatology, Catharina Hospital, Eindhoven (A.H.M.M.A., P.M.S.), and the Department of Dermatology, VieCuri Medical Center, Venlo (H.P.A.P.) - all in the Netherlands
| | - Han P A van Pelt
- From the Departments of Dermatology (M.H.E.J., J.P.H.M.K., N.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and Clinical Epidemiology and Medical Technology Assessment (B.A.B.E.), Maastricht University Medical Center, and the GROW School for Oncology and Developmental Biology (M.H.E.J., J.P.H.M.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and the Department of Epidemiology (P.J.N.), Maastricht University, Maastricht, the Department of Dermatology, Zuyderland Medical Center, Heerlen (J.P.H.M.K., P.J.F.Q.), the Department of Dermatology, Catharina Hospital, Eindhoven (A.H.M.M.A., P.M.S.), and the Department of Dermatology, VieCuri Medical Center, Venlo (H.P.A.P.) - all in the Netherlands
| | - Patricia J F Quaedvlieg
- From the Departments of Dermatology (M.H.E.J., J.P.H.M.K., N.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and Clinical Epidemiology and Medical Technology Assessment (B.A.B.E.), Maastricht University Medical Center, and the GROW School for Oncology and Developmental Biology (M.H.E.J., J.P.H.M.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and the Department of Epidemiology (P.J.N.), Maastricht University, Maastricht, the Department of Dermatology, Zuyderland Medical Center, Heerlen (J.P.H.M.K., P.J.F.Q.), the Department of Dermatology, Catharina Hospital, Eindhoven (A.H.M.M.A., P.M.S.), and the Department of Dermatology, VieCuri Medical Center, Venlo (H.P.A.P.) - all in the Netherlands
| | - Brigitte A B Essers
- From the Departments of Dermatology (M.H.E.J., J.P.H.M.K., N.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and Clinical Epidemiology and Medical Technology Assessment (B.A.B.E.), Maastricht University Medical Center, and the GROW School for Oncology and Developmental Biology (M.H.E.J., J.P.H.M.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and the Department of Epidemiology (P.J.N.), Maastricht University, Maastricht, the Department of Dermatology, Zuyderland Medical Center, Heerlen (J.P.H.M.K., P.J.F.Q.), the Department of Dermatology, Catharina Hospital, Eindhoven (A.H.M.M.A., P.M.S.), and the Department of Dermatology, VieCuri Medical Center, Venlo (H.P.A.P.) - all in the Netherlands
| | - Peter M Steijlen
- From the Departments of Dermatology (M.H.E.J., J.P.H.M.K., N.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and Clinical Epidemiology and Medical Technology Assessment (B.A.B.E.), Maastricht University Medical Center, and the GROW School for Oncology and Developmental Biology (M.H.E.J., J.P.H.M.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and the Department of Epidemiology (P.J.N.), Maastricht University, Maastricht, the Department of Dermatology, Zuyderland Medical Center, Heerlen (J.P.H.M.K., P.J.F.Q.), the Department of Dermatology, Catharina Hospital, Eindhoven (A.H.M.M.A., P.M.S.), and the Department of Dermatology, VieCuri Medical Center, Venlo (H.P.A.P.) - all in the Netherlands
| | - Nicole W J Kelleners-Smeets
- From the Departments of Dermatology (M.H.E.J., J.P.H.M.K., N.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and Clinical Epidemiology and Medical Technology Assessment (B.A.B.E.), Maastricht University Medical Center, and the GROW School for Oncology and Developmental Biology (M.H.E.J., J.P.H.M.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and the Department of Epidemiology (P.J.N.), Maastricht University, Maastricht, the Department of Dermatology, Zuyderland Medical Center, Heerlen (J.P.H.M.K., P.J.F.Q.), the Department of Dermatology, Catharina Hospital, Eindhoven (A.H.M.M.A., P.M.S.), and the Department of Dermatology, VieCuri Medical Center, Venlo (H.P.A.P.) - all in the Netherlands
| | - Klara Mosterd
- From the Departments of Dermatology (M.H.E.J., J.P.H.M.K., N.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and Clinical Epidemiology and Medical Technology Assessment (B.A.B.E.), Maastricht University Medical Center, and the GROW School for Oncology and Developmental Biology (M.H.E.J., J.P.H.M.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and the Department of Epidemiology (P.J.N.), Maastricht University, Maastricht, the Department of Dermatology, Zuyderland Medical Center, Heerlen (J.P.H.M.K., P.J.F.Q.), the Department of Dermatology, Catharina Hospital, Eindhoven (A.H.M.M.A., P.M.S.), and the Department of Dermatology, VieCuri Medical Center, Venlo (H.P.A.P.) - all in the Netherlands
| |
Collapse
|
16
|
Zhao W, Guan M, Nong X, Li Q, Chen Z. The safety and efficacy of daylight photodynamic therapy in the treatment of actinic keratoses: a systematic review and meta-analysis. Int J Dermatol 2018; 58:159-166. [PMID: 30198107 DOI: 10.1111/ijd.14211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/20/2018] [Accepted: 08/07/2018] [Indexed: 11/30/2022]
Abstract
Daylight photodynamic therapy (DLPDT) is a novel therapeutic approach for actinic keratoses (AKs). This study aimed to evaluate the safety and efficacy of DLPDT in treating patients with AKs as compared to conventional photodynamic therapy (CPDT). PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials were searched for relevant randomized controlled trials (RCTs) published before November 2017, based on the following search terms: "solar keratoses", "actinic keratoses", "photodynamic therapy", "daylight photodynamic therapy", "conventional photodynamic therapy", and "randomized". The complete response rate, patient satisfaction, and patient-reported pain after intervention with DLPDT or CPDT were primarily measured. Sensitivity analysis was conducted to determine the reliability of results. Begg's and Egger's tests were used to assess the likelihood of publication bias. Eight RCTs, comprising a total of 424 patients with AKs treated with DLPDT or CPDT, were included. No significant difference was found between the lesion response rate and the mean lesion response in a comparison of DLPDT and CPDT treatments. Generally, DLPDT was associated with higher patient satisfaction than CPDT. The patients who underwent DLPDT experienced less pain than those who underwent CPDT. Most of our results were of high stability and low sensitivity. Meanwhile, no statistical evidence of publication bias among studies was found under all comparisons. In conclusion, DLPDT is a safe and effective therapy, which could help in selecting the most appropriate therapeutic method for treating AKs and in guiding physicians to optimize treatment strategies.
Collapse
Affiliation(s)
- Weijia Zhao
- Department of Dermatology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Meng Guan
- Department of Ophthalmology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Xiang Nong
- Department of Dermatology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Qian Li
- Department of Dermatology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Zonghan Chen
- Office of Educational Administration, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan Province, China
| |
Collapse
|
17
|
A Single-Arm, Open-Label, Phase IV Study to Evaluate the Efficacy of a Topical Formulation for Hyperkeratotic Actinic Keratosis Lesions. Dermatol Ther (Heidelb) 2018; 8:455-462. [PMID: 30054800 PMCID: PMC6109024 DOI: 10.1007/s13555-018-0252-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Indexed: 01/03/2023] Open
Abstract
Introduction Actinic keratosis (AKs) are epidermal lesions that commonly occur in skin exposed to chronic cumulative UV irradiation. Untreated AK lesions can advance to squamous cell carcinoma. Current treatments of AK have many shortcomings; for instance, not all treatments can be used for the hyperkeratotic form of AK. The aim of this study was to test the efficacy and tolerability of a topical product containing 2,4,6-octatrienoic acid and urea for the treatment of hyperkeratotic AK lesions. Methods Forty male and female subjects with at least two hyperkeratotic AK lesions were enrolled in this single-arm, open-label phase IV study. The product was applied twice daily for two consecutive months. The efficacy endpoints were the reductions in the mean number of AK lesions per subject from baseline (T0) to the end of the trial (T1) and to three months after the end of the treatment period (T2). Results At T0, the mean (SD) number of lesions per subject was 3.65 (1.25). At the end of the treatment period (T1), this number had dropped (significantly, p < 0.0001) by 83.56%. The mean number of lesions per subject then decreased by 41.47% (p < 0.0001) between T1 and the three-month follow-up visit (T2). Complete elimination of lesions had occurred in 57.5% of the subjects at T1, and 82.5% (55% who had remained completely clear of lesions since T1, and 27.5% who had fully eliminated their lesions during the period from T1 to T2) at T2. No side effects were reported. Conclusion The application of a topical combination of 2,4,6-octatrienoic acid and urea twice daily for 60 consecutive days is a safe and effective treatment for hyperkeratotic AK lesions. Funding Giuliani SpA.
Collapse
|
18
|
Schmitz L, Gambichler T, Kost C, Gupta G, Stücker M, Stockfleth E, Dirschka T. Cutaneous squamous cell carcinomas are associated with basal proliferating actinic keratoses. Br J Dermatol 2018. [DOI: 10.1111/bjd.16536] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- L. Schmitz
- Department of Dermatology, Venereology and Allergology Ruhr‐University Gudrunstraße 56 D‐44791 Bochum Germany
| | - T. Gambichler
- Department of Dermatology, Venereology and Allergology Ruhr‐University Gudrunstraße 56 D‐44791 Bochum Germany
| | - C. Kost
- Department of Dermatology, Venereology and Allergology Ruhr‐University Gudrunstraße 56 D‐44791 Bochum Germany
| | - G. Gupta
- Department of Dermatology University Hospital Monklands Lanarkshire U.K
- School of Medicine University of Glasgow Glasgow U.K
| | - M. Stücker
- Department of Dermatology, Venereology and Allergology Ruhr‐University Gudrunstraße 56 D‐44791 Bochum Germany
| | - E. Stockfleth
- Department of Dermatology, Venereology and Allergology Ruhr‐University Gudrunstraße 56 D‐44791 Bochum Germany
| | - T. Dirschka
- CentroDerm Clinic Heinz‐Fangman‐Straße 57 Wuppertal Germany
- Faculty of Health University Witten‐Herdecke Alfred‐Herrhausen‐Straße 50 Witten Germany
| |
Collapse
|
19
|
Stockfleth E, Harwood CA, Serra-Guillén C, Larsson T, Østerdal ML, Skov T. Phase IV head-to-head randomized controlled trial comparing ingenol mebutate 0·015% gel with diclofenac sodium 3% gel for the treatment of actinic keratosis on the face or scalp. Br J Dermatol 2018; 178:433-442. [PMID: 29030864 DOI: 10.1111/bjd.16048] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ingenol mebutate (IngMeb) and diclofenac sodium (DS) are approved treatments for actinic keratosis (AK). OBJECTIVES To compare the efficacy and safety of IngMeb 0·015% gel with DS 3% gel (NCT02406014). METHODS Patients with 4-8 visible, discrete AK lesions on the face/scalp in a 25 cm2 contiguous area of skin were randomized 1:1 to IngMeb once-daily for three consecutive days or DS twice-daily for 90 days. Patients with AK lesions at Week 8 following IngMeb were offered a second IngMeb course. Primary end point was complete clearance of AK lesions (AKCLEAR 100) at end of first treatment course (Week 8, IngMeb; Week 17, DS). Secondary end points included AKCLEAR 100 at end of last treatment course and Week 17; adverse events (AEs) were assessed at these time points. Patients completed treatment satisfaction questionnaires for medication (TSQM; Week 17). RESULTS AKCLEAR 100 at end of first treatment course was higher with IngMeb (34%) vs. DS (23%; P = 0·006). AKCLEAR 100 at end of last IngMeb course (53%) and Week 17 (45%) was higher than DS (both P < 0·001). The most frequent AE was application-site erythema (IngMeb 19%; DS 12%). Treatment-related AE (TRAE) duration was shorter with IngMeb. TRAE withdrawals were lower for IngMeb (2%) vs. DS (6%). TSQM scores for global satisfaction (P < 0·001) and effectiveness (P = 0·002) were higher with IngMeb, as was dosing instruction adherence (≥ 90% vs. 70%). CONCLUSIONS AKCLEAR 100, patient treatment satisfaction and effectiveness were significantly higher with IngMeb compared with DS, demonstrating superiority of IngMeb for AK treatment on face/scalp.
Collapse
Affiliation(s)
- E Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Bochum, Germany
| | - C A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, U.K
| | - C Serra-Guillén
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | | | | | - T Skov
- LEO Pharma A/S, Ballerup, Denmark
| |
Collapse
|
20
|
Casari A, Chester J, Pellacani G. Actinic Keratosis and Non-Invasive Diagnostic Techniques: An Update. Biomedicines 2018; 6:biomedicines6010008. [PMID: 29316678 PMCID: PMC5874665 DOI: 10.3390/biomedicines6010008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/26/2017] [Accepted: 12/19/2017] [Indexed: 12/15/2022] Open
Abstract
Actinic keratosis represents the earliest manifestation of non-melanoma skin cancer. Because of their risk of progression to invasive squamous cell carcinoma, an earlier diagnosis and treatment are mandatory. Their diagnosis sometimes could represent a challenge even for expert dermatologists. Dermoscopy, confocal laser microscopy and optical coherence tomography could help clinicians in diagnosis.
Collapse
Affiliation(s)
- Alice Casari
- Clinica Dermatologica, Policlinico di Modena, Via del Pozzo 70, 41124 Modena, Italy.
| | - Johanna Chester
- Clinica Dermatologica, Policlinico di Modena, Via del Pozzo 70, 41124 Modena, Italy.
| | - Giovanni Pellacani
- Clinica Dermatologica, Policlinico di Modena, Via del Pozzo 70, 41124 Modena, Italy.
| |
Collapse
|
21
|
Albibas AA, Rose-Zerilli MJ, Lai C, Pengelly RJ, Lockett GA, Theaker J, Ennis S, Holloway JW, Healy E. Subclonal Evolution of Cancer-Related Gene Mutations in p53 Immunopositive Patches in Human Skin. J Invest Dermatol 2018; 138:189-198. [DOI: 10.1016/j.jid.2017.07.844] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 07/12/2017] [Accepted: 07/25/2017] [Indexed: 11/27/2022]
|
22
|
Milam P, Korman A, Kaffenberger J. Frequent skin examinations in patients with actinic keratoses: Ethical, financial, and moral implications. J Am Acad Dermatol 2017; 77:985-987. [PMID: 29029915 DOI: 10.1016/j.jaad.2017.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 02/20/2017] [Accepted: 03/12/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Philip Milam
- Ohio State University, Division of Dermatology, Department of Internal Medicine, Columbus, Ohio
| | - Abraham Korman
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jessica Kaffenberger
- Ohio State University, Division of Dermatology, Department of Internal Medicine, Columbus, Ohio.
| |
Collapse
|
23
|
High Patient Satisfaction with Daylight-Activated Methyl Aminolevulinate Cream in the Treatment of Multiple Actinic Keratoses: Results of an Observational Study in Australia. Dermatol Ther (Heidelb) 2017; 7:525-533. [PMID: 28905294 PMCID: PMC5698198 DOI: 10.1007/s13555-017-0199-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Indexed: 12/26/2022] Open
Abstract
Introduction Actinic keratoses (AK) are treated to reduce the risk of progression to squamous cell carcinoma and for symptomatic and cosmetic benefits. The objective of this observational study was to generate real-life data on the use of daylight photodynamic therapy with methyl aminolevulinate cream (MAL DL-PDT) in treating mild to moderate facial/scalp AK. Methods A multicenter, prospective, observational study was conducted in Australia in patients receiving a single treatment of MAL DL-PDT for mild to moderate AK. Efficacy was assessed 3 months after treatment by investigator-assessed improvement and patient- and physician-completed satisfaction questionnaires. Adverse events were recorded throughout the study. Results Overall, 81 patients were enrolled of mean age 62.7 years, mostly men (76.5%) with skin phototype I (64.2%) or II (35.8%) and a long history of AK (mean duration 16.8 years). Most had multiple lesions (82.7% had >10 lesions) of predominantly grade I (75.3%). At 3 months after treatment, almost half the patients (46.8%) required no further treatment. The proportions of patients and physicians satisfied to very satisfied with the MAL DL-PDT treatment were 79.7% and 83.3%, respectively. After receiving the treatment, 74.1% of patients indicated via the questionnaire that they were not bothered at all by the pain. Related AEs were reported in 48.1% of patients, mainly mild erythema (44.4%). Conclusions In clinical practice in Australia, the use of MAL DL-PDT in treating multiple mild to moderate non-hyperkeratotic AK of the face and/or scalp results in high levels of patient and physician satisfaction reflecting the good efficacy and tolerability of this almost painless, convenient procedure. Trial Registration ClinicalTrials.gov identifier, NCT02674048. Funding Galderma R&D.
Collapse
|
24
|
Kricker A, Weber M, Sitas F, Banks E, Rahman B, Goumas C, Kabir A, Hodgkinson VS, van Kemenade CH, Waterboer T, Armstrong BK. Early Life UV and Risk of Basal and Squamous Cell Carcinoma in New South Wales, Australia. Photochem Photobiol 2017; 93:1483-1491. [PMID: 28710897 DOI: 10.1111/php.12807] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/17/2017] [Indexed: 11/28/2022]
Abstract
Sun exposure is the main cause of squamous (SCC) and basal cell carcinoma (BCC) although pattern and amount differ by cancer type, and sun sensitivity is the major host risk factor. Our study investigated risk factors and residential ambient UV in a population-based sample of Australian 45 and Up Study participants: 916 BCC cases, 433 SCC cases, 1224 controls. Unconditional logistic regression models adjusting for key covariates demonstrated 60% increased BCC risk and two-fold increased SCC risk with sun sensitivity, and three- and four-fold increased risk, respectively, with solar keratoses. BCC but not SCC risk increased with higher early-life residential UV in all participants (odds ratio (OR) = 1.54; 95% CI 1.22-1.96 for intermediate; OR = 1.31; 95% CI 1.03-1.68 for high UV at birthplace) and similarly in Australian-born participants (P-values < 0.05). Risk of SCC but not BCC increased with long-term cumulative sun exposure assessed by self-reported outdoor work (OR 1.74, 95% CI 1.21-2.49). In conclusion, sun sensitivity is important for both cancers, early-life UV but not cumulative UV appears to increase BCC risk, the former an apparently novel finding, and SCC risk appears only to be related to long-term cumulative sun exposure.
Collapse
Affiliation(s)
- Anne Kricker
- Sydney Medical School, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Marianne Weber
- Sydney Medical School, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Cancer Research Division, Cancer Council New South Wales, Sydney, NSW, Australia
| | - Freddy Sitas
- Sydney Medical School, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia.,Sax Institute, Sydney, NSW, Australia
| | - Bayzidur Rahman
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Chris Goumas
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Ahsanul Kabir
- Department of Environment and Geography, Faculty of Science, Formerly Geographic Information Systems, Macquarie University, Sydney, NSW, Australia
| | - Verity S Hodgkinson
- Cancer Research Division, Cancer Council New South Wales, Sydney, NSW, Australia
| | | | - Tim Waterboer
- Molecular Diagnostics of Oncogenic Infections Division, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Bruce K Armstrong
- Sydney Medical School, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,School of Population Health, University of Western Australia, Perth, WA, Australia
| |
Collapse
|
25
|
Berry K, Butt M, Kirby JS. Influence of Information Framing on Patient Decisions to Treat Actinic Keratosis. JAMA Dermatol 2017; 153:421-426. [PMID: 28114674 DOI: 10.1001/jamadermatol.2016.5245] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Importance Actinic keratosis (AK) is a skin growth induced by UV light exposure that requires long-term management because a small proportion of the disease can progress to squamous cell carcinoma. The influence of how clinicians frame or present information to patients may affect decision making about AK. Objective To evaluate the differences in patients' decisions on whether to receive treatment for AK related to information presentation or choice framing. Design, Setting, and Participants A prospective survey study was performed from June 1 to July 31, 2016, in participants who were able to read English. Participants were recruited through the Penn State Milton S. Hershey Dermatology Clinic and an online survey site. The survey was conducted through an online portal. A total of 571 individuals were recruited. Regression analysis, correlation coefficient analysis, and test-retest validation were conducted. Main Outcomes and Measures The proportions of patients choosing to receive treatment for AK. Analyses were performed to adjust for age, sex, educational level, history of skin cancer, and history of AK. Results Of the 571 recruited participants, 539 (94.4%) returned completed surveys. The mean (SD) age of respondents was 42.9 (17.8) years; 306 (56.8%) were women. The decision to receive treatment for AK varied from 57.7% (n = 311) to 92.2% (n = 497) for the 5 scenarios presented in the questions (P < .001). The question that presented AK as a "precancer" had the highest proportion of participants who preferred treatment (497 [92.2%]). Two questions that presented the risk of AK as not progressing to cancer had the lowest proportion of individuals who chose treatment (311 [57.7%] and 328 [60.9%]). Participants from the clinic and from the online portal were significantly different in age (mean [SD] age, 56.1 [17.6] vs 33.3 [10.0] years), sex (145 [63.6%] vs 161 [51.8%] were females), educational level (40 [17.5%] vs 80 [25.7%] had completed some graduate school), history of AK (46 [20.2%] vs 19 [6.1%] answered yes), and history of skin cancer (76 [33.3%] vs 15 [4.8%] answered yes) (all P ≤ .001). Based on a regression analysis, age, sex, and previous diagnosis of skin cancer were not significantly associated with the participants' responses. Conclusions and Relevance This study found that patients' decisions on whether to receive treatment for AK is significantly affected by physician wording, especially with alterations in the presentation of risk of malignant transformation.
Collapse
Affiliation(s)
- Katherine Berry
- Student, Penn State College of Medicine, Hershey, Pennsylvania
| | - Melissa Butt
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| |
Collapse
|
26
|
The natural history of actinic keratoses in organ transplant recipients. J Am Acad Dermatol 2017; 76:162-164. [PMID: 27986142 DOI: 10.1016/j.jaad.2016.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 09/02/2016] [Accepted: 09/04/2016] [Indexed: 11/22/2022]
|
27
|
Kirby JS, Gregory T, Liu G, Leslie DL, Miller JJ. Variation in the Cost of Managing Actinic Keratosis. JAMA Dermatol 2017; 153:264-269. [PMID: 28249074 DOI: 10.1001/jamadermatol.2016.4733] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Actinic keratosis (AK), a skin growth induced by ultraviolet light exposure, requires chronic management because a small proportion can progress into squamous cell skin cancer. Spending for AK management was more than $1 billion in 2004. Investigating geographic variation in AK spending presents an opportunity to decrease waste or recoup excess spending. Objective To evaluate geographic variation in health care cost for management of AKs and the association with patient-related and health-related factors. Design, Setting, and Participants This retrospective cohort study was performed using data from the MarketScan medical claims database of 488 324 continuously enrolled members with 2 or more claims for AK. Data from January 1, 2008, to December 31, 2012, was used. Main Outcomes and Measures Annual costs of care were calculated for outpatient visits, AK destruction, and medications for AKs, and the total of these components. Costs were adjusted for inflation to 2014 US dollars. To display cost variation, we calculated the ratio of mean cost in the highest quintile (Q5) relative to the mean in the lowest quintile (Q1), or the Q5:Q1 ratio; Q5:Q1 ratios were adjusted based on age, sex, history of nonmelanoma skin cancer, US geographic region, and population density (metropolitan statistical area). Results Overall, data from 488 324 continuously enrolled members (mean [SD] age, 53.1 [7.5] years; 243 662 women) with 2 or more claims for AK were included. Overall, patients had 1 085 985 claims related to AK, and dermatologists accounted for 71.0% of claims. The 2-year total cost was $111.5 million, with $52.4 million in 2011 and $59.1 million in 2012. The unadjusted Q5:Q1 ratios for total annual cost per patient ranged from 9.49 to 15.10. Adjusted ratios ranged from 1.72 to 1.80. Conclusions and Relevance There is variation in AK management cost within and between regions. This is not fully explained by differences in patient characteristics such as age, sex, or comorbidities. The annual cost for 10 common conditions from Medicare had lower Q5:Q1 ratios that ranged from 1.33 (joint degeneration of back/neck) to 1.69 (chronic sinusitis) when compared with 1.72 to 1.80 for AKs. This suggests an opportunity to investigate and improve the value of health care delivery in the management of AKs.
Collapse
Affiliation(s)
- Joslyn S Kirby
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Guodong Liu
- Department of Public Health Sciences, Penn State-Hershey, Hershey, Pennsylvania
| | - Douglas L Leslie
- Department of Public Health Sciences, Penn State-Hershey, Hershey, Pennsylvania
| | - Jeffrey J Miller
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| |
Collapse
|
28
|
Gollnick HPM. [Early detection of actinic keratoses]. MMW Fortschr Med 2017; 159:57-63. [PMID: 28357766 DOI: 10.1007/s15006-017-9042-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Harald P M Gollnick
- Universitätsklinik für Dermatologie und Venerologie, Otto-von-Guericke Universität, Leipzigerstraße 44, D-39120, Magdeburg, Deutschland.
| |
Collapse
|
29
|
Dirschka T, Gupta G, Micali G, Stockfleth E, Basset-Séguin N, Del Marmol V, Dummer R, Jemec GBE, Malvehy J, Peris K, Puig S, Stratigos AJ, Zalaudek I, Pellacani G. Real-world approach to actinic keratosis management: practical treatment algorithm for office-based dermatology. J DERMATOL TREAT 2016; 28:431-442. [DOI: 10.1080/09546634.2016.1254328] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Thomas Dirschka
- Centroderm Clinic, Wuppertal, and Faculty of Health, University of Witten-Herdecke, Witten, Germany
| | - Girish Gupta
- Department of Dermatology, Monklands Hospital, Lanarkshire, and University of Glasgow, Glasgow, UK
| | | | - Eggert Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | | | - Véronique Del Marmol
- Department of Dermatology, Hôpital Erasme – Université Libre de Bruxelles, Bruxelles, Belgium
| | - Reinhard Dummer
- Department of Dermatology Skin Cancer Unit, University Hospital Zürich, Zurich, Switzerland
| | - Gregor B. E. Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde; Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Josep Malvehy
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | - Ketty Peris
- Department of Dermatology, Catholic University of Rome, Largo A. Gemelli 8, Rome, Italy
| | - Susana Puig
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | - Alexander J. Stratigos
- First Department of Dermatology-Venereology, University of Athens Medical School, Andreas Sygros Hospital, Athens, Greece
| | - Iris Zalaudek
- Non-Melanoma Skin Cancer Unit, Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
30
|
Siegel JA, Korgavkar K, Weinstock MA. Current perspective on actinic keratosis: a review. Br J Dermatol 2016; 177:350-358. [PMID: 27500794 DOI: 10.1111/bjd.14852] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2016] [Indexed: 02/05/2023]
Abstract
Actinic keratoses (AKs) are common, with prevalence in the U.S.A. estimated at almost 40 million in 2004 and annual costs of > $1 billion (U.S.D.). However, there is no universally accepted definition of AK and thus it is difficult to identify reliably. AKs are lesions of epidermal keratinocytic dysplasia that result from chronic sun exposure and have the ability to progress to invasive squamous cell carcinoma (SCC), but clinicians disagree about whether AKs are premalignant lesions, superficial SCCin situ or epiphenomena of chronically sun-damaged skin. Yearly AK to SCC progression rates of 0·6% were reported in an elderly population with multiple prior keratinocyte carcinomas (KCs); and rates of spontaneous AK regression have been reported to be > 50%, but regressed lesions often reappear. As AKs have both cosmetic consequences and potential for malignant transformation, there are multiple reasons for treatment. There is no current agreement on the most efficacious treatment, but 5-fluorouracil has been shown to both prevent and treat AKs, and imiquimod and photodynamic therapy may have the best cosmetic outcomes. AKs may be treated to improve appearance and relieve symptoms, but the keratinocytic dysplasia that gives rise to malignancy, and sometimes appears as an AK, may be what actually threatens patient health. Thus, treatments should aim to decrease the risk of KC or facilitate KC diagnosis by reducing the potential for misidentification created when a KC appears in a field of AKs. Improved agreement among clinicians on AK definition may improve management.
Collapse
Affiliation(s)
- J A Siegel
- Center for Dermatoepidemiology-111D, Veterans Affairs Medical Center, Providence, RI, U.S.A.,Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, RI, U.S.A
| | - K Korgavkar
- Center for Dermatoepidemiology-111D, Veterans Affairs Medical Center, Providence, RI, U.S.A.,Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, RI, U.S.A
| | - M A Weinstock
- Center for Dermatoepidemiology-111D, Veterans Affairs Medical Center, Providence, RI, U.S.A.,Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, RI, U.S.A
| |
Collapse
|
31
|
Poulin Y, Lynde CW, Barber K, Vender R, Claveau J, Bourcier M, Ashkenas J. Non-melanoma Skin Cancer in Canada Chapter 3: Management of Actinic Keratoses. J Cutan Med Surg 2016; 19:227-38. [DOI: 10.1177/1203475415583414] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background Actinic keratosis (AK) and cheilitis (AC) are lesions that develop on photodamaged skin and may progress to form invasive squamous cell carcinomas (SCCs). Objective To provide guidance to Canadian health care practitioners regarding management of AKs and ACs. Methods Literature searches and development of graded recommendations were carried out as discussed in the accompanying introduction (chapter 1 of the NMSC guidelines). Results Treatment of AKs allows for secondary prevention of skin cancer in sun-damaged skin. Because it is impossible to predict whether a given AK will regress, persist, or progress, AKs should ideally be treated. This chapter discusses options for the management of AKs and ACs. Conclusions Treatment options include surgical removal, topical treatment, and photodynamic therapy. Combined modalities may be used in case of inadequate response. AKs are particularly common following the longterm immunosuppression in organ transplant patients, who should be monitored frequently to identify emerging lesions that require surgery.
Collapse
Affiliation(s)
- Yves Poulin
- Centre Dermatologique du Québec Métropolitain, Québec, QC, Canada
- Université Laval, Québec, QC, Canada
| | - Charles W. Lynde
- Lynderm Research Inc, Markham, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Kirk Barber
- Kirk Barber Research, Calgary, AB, Canada
- University of Calgary, Calgary, AB, Canada
| | - Ronald Vender
- Dermatrials Research, Hamilton, ON, Canada
- McMaster University, Hamilton, ON, Canada
| | - Joël Claveau
- Clinique Dermatologique Joël Claveau, Québec, QC, Canada
| | - Marc Bourcier
- Durondel CP Inc, Moncton, NB, Canada
- Université de Sherbrooke, Sherbrooke, QC, Canada
| | | |
Collapse
|
32
|
Foley P, Stockfleth E, Peris K, Basset-Seguin N, Cerio R, Antonio Sanches J, Guillen C, Farrington E, Lebwohl M. Adherence to topical therapies in actinic keratosis: A literature review. J DERMATOL TREAT 2016; 27:538-545. [DOI: 10.1080/09546634.2016.1178372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
33
|
Peris K, Calzavara-Pinton PG, Neri L, Girolomoni G, Malara G, Parodi A, Piaserico S, Rossi R, Pellacani G. Italian expert consensus for the management of actinic keratosis in immunocompetent patients. J Eur Acad Dermatol Venereol 2016; 30:1077-84. [PMID: 27060910 DOI: 10.1111/jdv.13648] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/15/2016] [Indexed: 12/27/2022]
Abstract
Actinic keratosis (AK) is a common skin disease which can potentially progress to invasive squamous cell carcinoma (iSCC). Given that mortality rates and health-care cost associated with iSCC are substantial, the management of AK represents an important public health issue. Several effective lesion-directed and field-directed treatments are available. Ablative procedures (e.g. cryosurgery, excision, laser ablation, curettage alone or with electrodessication) are considered cost-effective options for solitary lesions. Field-directed therapies (e.g. Ingenol Mebutate, imiquimod, PDT, 5-Fluorouracile, diclofenac 3%, 5-FU + Salicylic acid) can be used over large epidermal surfaces and are directed to treat both individual visible lesions and cancerization fields. In order to provide guidance for management choice in clinical practice, several guidelines concerning the diagnosis and treatment of AK have been published in the past decade. However, the introduction of novel therapeutic options requires continuous updates of recommendations and adaptation to national contexts. The present review summarizes the existing evidence and reports the results of a consensus workshop on the management of AK.
Collapse
Affiliation(s)
- K Peris
- Unit of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - P G Calzavara-Pinton
- Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
| | - L Neri
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - G Girolomoni
- Unit of Dermatology, University of Verona, Verona, Italy
| | - G Malara
- Unit of Dermatology, AO Papardo, Messina, Italy
| | - A Parodi
- Dermatology Clinic, AO San Martino, University of Genoa, Genoa, Italy
| | - S Piaserico
- Division of Dermatology, Department of Medicine, University of Padua, Padua, Italy
| | - R Rossi
- Division of Dermatology, University of Florence, Florence, Italy
| | - G Pellacani
- Unit of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
34
|
Zhao Y, Li C, Wen C, Wei Y, Li R, Wang G, Tu P. The prevalence of actinic keratosis in patients visiting dermatologists in two hospitals in China. Br J Dermatol 2016; 174:1005-10. [PMID: 26650251 DOI: 10.1111/bjd.14344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Y. Zhao
- Department of Dermatology; Beijing Tsinghua Changgung Hospital; Medical Center; Tsinghua University; No. 168 Litang Road Dongxiaokou Town Changping District Beijing 102218 China
- Department of Dermatology and Venereology; Peking University First Hospital; No. 8 Xishiku Street Xicheng District Beijing 100034 China
| | - C.Y. Li
- Department of Dermatology; Xijing Hospital; Fourth Military Medical University; Xi'an 710032 China
| | - C.M. Wen
- Department of Dermatology; Civil Aviation General Hospital; No. 1 Chaowai Gaojiajin Beijing 100123 China
| | - Y.B. Wei
- Department of Dermatology; Xijing Hospital; Fourth Military Medical University; Xi'an 710032 China
| | - R.Y. Li
- Department of Dermatology and Venereology; Peking University First Hospital; No. 8 Xishiku Street Xicheng District Beijing 100034 China
| | - G. Wang
- Department of Dermatology; Xijing Hospital; Fourth Military Medical University; Xi'an 710032 China
| | - P. Tu
- Department of Dermatology and Venereology; Peking University First Hospital; No. 8 Xishiku Street Xicheng District Beijing 100034 China
| |
Collapse
|
35
|
Schmitz L, Kahl P, Majores M, Bierhoff E, Stockfleth E, Dirschka T. Actinic keratosis: correlation between clinical and histological classification systems. J Eur Acad Dermatol Venereol 2016; 30:1303-7. [PMID: 26955898 DOI: 10.1111/jdv.13626] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 01/18/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND There are several clinical and histological classification systems for grading actinic keratosis (AK) lesions. The Olsen clinical classification scheme grades AK lesions according to their thickness and degree of hyperkeratosis (grades 1-3). The Roewert-Huber histological classification system grades AK lesions based on the extent of epidermal atypical keratinocytes (AK I-III). OBJECTIVE The aim of this study was to determine whether there is a correlation between these clinical and histological AK classification schemes. METHODS One AK lesion from patients in three pivotal clinical studies and routine practice was assessed clinically and histologically. A match in grading was defined as Olsen grade 1 being classified histologically as AK I, Olsen grade 2 as AK II and Olsen grade 3 as AK III. RESULTS Of the 892 lesions included, 29.0% were classified as Olsen grade 1, 59.6% as Olsen grade 2 and 11.3% as Olsen grade 3; 19.2% were histologically classified as AK I, 69.6% as AK II and 11.2% as AK III. Only 480 lesions (53.8%) had a matching clinical and histological classification. Of these matches, most were 'Olsen grade 2 = AK II' (83.1%). The Spearman's rank correlation coefficient for clinical and histological classification was r = 0.0499 (P = 0.137). CONCLUSIONS Clinical classification of AK lesions using the system of Olsen does not accurately match histological classification of the same lesions using the system of Roewert-Huber. Consequently, it is not possible to draw conclusions about the histology of AK lesions from their clinical appearance. This finding reinforces the need to treat all AK lesions as well as field cancerization.
Collapse
Affiliation(s)
- L Schmitz
- Department of Dermatology, Ruhr-University, Bochum, Germany.,CentroDerm GmbH, Wuppertal, Germany
| | - P Kahl
- Heinz-Werner-Seifert-Institute of Dermatopathology, Bonn, Germany
| | - M Majores
- Heinz-Werner-Seifert-Institute of Dermatopathology, Bonn, Germany
| | - E Bierhoff
- Heinz-Werner-Seifert-Institute of Dermatopathology, Bonn, Germany
| | - E Stockfleth
- Department of Dermatology, Ruhr-University, Bochum, Germany
| | - T Dirschka
- CentroDerm GmbH, Wuppertal, Germany.,Faculty of Health, University Witten-Herdecke, Witten, Germany
| |
Collapse
|
36
|
Garbe C, Basset-Seguin N, Poulin Y, Larsson T, Østerdal ML, Venkata R, Lear JT. Efficacy and safety of follow-up field treatment of actinic keratosis with ingenol mebutate 0·015% gel: a randomized, controlled 12-month study. Br J Dermatol 2016; 174:505-13. [PMID: 26471889 DOI: 10.1111/bjd.14222] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Ingenol mebutate (IngMeb) is a novel patient-applied topical field therapy for actinic keratosis. OBJECTIVES To demonstrate the efficacy and safety of follow-up IngMeb field treatment of actinic keratoses (AKs) present at 8 weeks after initial treatment or emerging in a previously cleared field. METHODS In this phase III, randomized, double-blind study in patients with 4-8 clinically visible AKs within a contiguous 25-cm(2) treatment area on the face or scalp, all patients were treated initially with IngMeb 0·015% gel for three consecutive days. If lesions were present in the field at 8 weeks, or emerged at weeks 26 or 44, patients were randomized (2 : 1) to follow-up IngMeb or vehicle gel for three consecutive days. The main outcome was complete clearance rates of AKs 8 weeks after randomization. RESULTS Of 450 patients who received initial treatment with IngMeb, 61·6% demonstrated complete clearance at 8 weeks. Patients with AKs present at 8 weeks or emerging at weeks 26 or 44 were randomized to IngMeb (n = 134) or vehicle (n = 69). IngMeb achieved a higher complete clearance rate than vehicle 8 weeks after randomization in AKs present at 8 weeks (46·7% vs. 18·4%; P < 0·01) and in emergent AKs (59·5% vs. 25·0%; P = 0·01). Based on those who completed 12 months of follow-up (n = 340), the overall 12-month clearance rate was estimated at 50·0%. Follow-up IngMeb treatment was well tolerated. CONCLUSIONS This study demonstrated the long-term benefit of IngMeb 0·015% gel for initial and follow-up therapy of AKs.
Collapse
Affiliation(s)
- C Garbe
- Department of Dermatology, Division of Dermatooncology, University Hospital Tübingen, Tübingen, 72076, Germany
| | | | - Y Poulin
- Laval University, Quebec City, QC, Canada.,Center for Research in Dermatology, Quebec City, QC, Canada
| | | | | | | | - J T Lear
- Department of Dermatology, Manchester Royal Infirmary and Manchester Academics Health Science Centre, Manchester University, Manchester, U.K
| |
Collapse
|
37
|
Werner R, Stockfleth E, Connolly S, Correia O, Erdmann R, Foley P, Gupta A, Jacobs A, Kerl H, Lim H, Martin G, Paquet M, Pariser D, Rosumeck S, Röwert-Huber HJ, Sahota A, Sangueza O, Shumack S, Sporbeck B, Swanson N, Torezan L, Nast A. Evidence- and consensus-based (S3) Guidelines for the Treatment of Actinic Keratosis - International League of Dermatological Societies in cooperation with the European Dermatology Forum - Short version. J Eur Acad Dermatol Venereol 2015; 29:2069-79. [DOI: 10.1111/jdv.13180] [Citation(s) in RCA: 188] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/02/2015] [Indexed: 12/22/2022]
Affiliation(s)
- R.N. Werner
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - E. Stockfleth
- Department of Dermatology, Venerology and Allergology; Skin Cancer Center (HTCC); Charité - Universitätsmedizin Berlin; Berlin Germany
| | - S.M. Connolly
- Department of Dermatology; Mayo Clinic; Scottsdale Arizona USA
| | - O. Correia
- Centro Dermatologia Epidermis; Instituto CUF and Faculty of Medicine of University of Porto; Porto Portugal
| | - R. Erdmann
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - P. Foley
- Skin and Cancer Foundation Victoria; Carlton Victoria Australia
- St. Vincent's Hospital Melbourne; Fitzroy Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
| | - A.K. Gupta
- Division of Dermatology; Department of Medicine; University of Toronto; Toronto Ontario Canada
- Mediprobe Research Inc.; London Ontario Canada
| | - A. Jacobs
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - H. Kerl
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - H.W. Lim
- Department of Dermatology; Henry Ford Hospital; Detroit Michigan USA
| | - G. Martin
- Dermatology Laser Center of Maui; Kihei Hawaii USA
| | - M. Paquet
- Mediprobe Research Inc.; London Ontario Canada
| | - D.M. Pariser
- Division of Dermatology and Virginia Clinical Research Inc; Eastern Virginia Medical School; Norfolk Virginia USA
| | - S. Rosumeck
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - H.-J. Röwert-Huber
- Division of Dermatopathology; Department of Dermatology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - A. Sahota
- Department of Dermatology; Whipps Cross University Hospital; London UK
| | - O.P. Sangueza
- Department of Pathology; Wake Forest Baptist Medical Center; Winston-Salem North Carolina USA
- Department of Dermatology; Wake Forest Baptist Medical Center; Winston-Salem North Carolina USA
| | - S. Shumack
- Department of Dermatology; Northern Medical School; University of Sydney; Sydney New South Wales Australia
| | - B. Sporbeck
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - N.A. Swanson
- Dermatology, Surgery, and Otolaryngology; Oregon Health and Science University; Portland Oregon USA
- Surgical and Cosmetic Dermatology and Clinical Operations; Oregon Health and Science University Knight Cancer Institute; Portland Oregon USA
| | - L. Torezan
- Faculty of Medicine; Hospital das Clínicas; Universidade de São Paulo; São Paulo Brazil
| | - A. Nast
- Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology; Charité - Universitätsmedizin Berlin; Berlin Germany
| |
Collapse
|
38
|
Costa C, Scalvenzi M, Ayala F, Fabbrocini G, Monfrecola G. How to treat actinic keratosis? An update. J Dermatol Case Rep 2015; 9:29-35. [PMID: 26236409 DOI: 10.3315/jdcr.2015.1199] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 06/17/2015] [Indexed: 12/21/2022]
Abstract
Actinic keratosis (AKs) is one of the most common skin lesions leading to an increased risk of developing squamous cell carcinoma and other skin malignancies. The lesions principally arise as a result of excessive ultraviolet (UV) exposure. AKs may regress spontaneously, remain stable or evolve to invasive squamous cell carcinoma. The risk of squamous cell carcinoma is significantly increased patients with more than 5 AKs. The main mechanisms involved in the formation of AK are inflammation, mutagenesis, oxidative stress, impaired apoptosis, immunosuppression, disregulation of cell growth and proliferation, and tissue remodeling. Human papilloma virus has also been correlated with the formation of some AKs. As an individual ages, his skin is exposed to increasing cumulative amounts of UV light and other environmental insults. This is especially true for the head, neck and forearms. These insults do not target only the skin where individual lesions develop, but also the surrounding area. In this area undetectable preclinical AK lesions or dysplastic cells may be present. The whole affected area is known as the 'field'. Therefore, management is divided into lesion-directed and field-directed therapies. Currently, the therapies in use are lesion-directed cryotherapy and/or excision, and field-directed topical agents: 5-fluorouracil, diclofenac, photodynamic therapy, imiquimod, and ingenol mebutate. Combining lesion- and field-directed therapies showed good results and several novel therapies are under investigation. Treatment is variable and personalized, what makes a gold standard management algorithm difficult to design. This review aims to describe the rationale behind the available treatment options for AKs based on current understanding of pathophysiology and epidemiology.
Collapse
Affiliation(s)
- Claudia Costa
- Department of Dermatology, Federico II University, Naples, Italy
| | | | - Fabio Ayala
- Department of Dermatology, Federico II University, Naples, Italy
| | | | | |
Collapse
|
39
|
Eder J, Prillinger K, Korn A, Geroldinger A, Trautinger F. Prevalence of actinic keratosis among dermatology outpatients in Austria. Br J Dermatol 2014; 171:1415-21. [PMID: 24864059 DOI: 10.1111/bjd.13132] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Actinic keratoses (AKs) are common precursors of squamous cell carcinomas (SCCs) of the skin making them an important public health issue with information on their prevalence widely lacking. OBJECTIVES To define the prevalence of AK in dermatology outpatients in Austria and to identify more accurately the target population for AK screening, treatment and prevention. METHODS Each of the 48 randomly selected Austrian office-based dermatologists simultaneously screened 100 consecutive patients (aged ≥ 30 years) for the presence of AK. RESULTS In total, 4449 evaluable patients showed an overall AK prevalence of 31·0%, which was higher in men (39·2%) than in women (24·3%) and increased with age in both sexes. AK distribution among sun-exposed body sites and extent of disease varied with sex and region. CONCLUSIONS In Austria, AKs are common among dermatology outpatients, who have access to professional education and treatment. Investigations regarding the efficacy of routine AK screening in dermatology outpatients for the prevention of invasive SCC is warranted.
Collapse
Affiliation(s)
- J Eder
- Department of Dermatology and Venereology, Karl Landsteiner University of Health Sciences, St. Pölten, Austria; Karl Landsteiner Institute of Dermatological Research, St. Pölten, Austria
| | | | | | | | | |
Collapse
|
40
|
Simon JC, Dominicus R, Karl L, Rodríguez R, Willers C, Dirschka T. A prospective randomized exploratory study comparing the efficacy of once-daily topical 0.5% 5-fluorouracil in combination with 10.0% salicylic acid (5-FU/SA) vs. cryosurgery for the treatment of hyperkeratotic actinic keratosis. J Eur Acad Dermatol Venereol 2014; 29:881-9. [PMID: 25257941 DOI: 10.1111/jdv.12702] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 07/17/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Actinic keratoses (AKs) are clinically significant and require therapy. Efficacy of low-dose (0.5%) 5-fluorouracil with 10% salicylic acid (5-FU/SA) has been shown in randomized comparative trials of hyperkeratotic lesions of various grades. OBJECTIVES To evaluate the efficacy, tolerability and safety of low-dose 5-FU/SA topical solution vs. cryosurgery in patients with moderate/severe (grade II/III) hyperkeratotic AKs (NCT01358851). METHODS In an exploratory, open, randomized study, patients with histologically confirmed moderate/severe hyperkeratotic AKs on the face/forehead or bald scalp received 6 weeks of once-daily topical 0.5% 5-FU/SA, or up to two cryosurgery treatments (3 weeks apart). Histological outcomes were determined from punch biopsies. Clinical, cosmetic and tolerability outcomes were also assessed. RESULTS Sixty-six patients received treatment (33 per arm). The baseline total number of lesions was 266 (8.1/patient) in the 0.5% 5-FU/SA and 263 (8.0/patient) in the cryosurgery group. Most (74.5%) lesions were grade II (grade III, 25.5%). Mean change in lesion count from baseline to Day 98 was -5.2 and -5.7 lesions per patient for 0.5% 5-FU/SA and cryotherapy groups respectively. Histological AK clearance rates on Day 98 were 62.1% and 41.9% respectively. At 6-month posttreatment follow-up, recurrence of cleared lesions (no clinically visible lesions in treatment area) occurred in 39.4% of 0.5% 5-FU/SA and 84.8% of cryosurgery patients. Drug-related adverse events (AEs), including local skin reactions considered 'severe' by the investigator, were reported in 24.2% of 0.5% 5-FU/SA and 6.1% of cryosurgery patients. All drug-related AEs were skin reactions. CONCLUSIONS Although the study was not powered to explore statistical differences in clinical efficacy between treatments, a short (6-week) schedule of topical treatment with 0.5% 5-FU/SA achieved greater histological clearance and lower recurrence of grade II/III hyperkeratotic AKs than cryosurgery. AE incidence across both treatment groups was relatively low and AEs were generally mild or moderate. Clinical trials.gov identifier: NCT01358851.
Collapse
Affiliation(s)
- J-C Simon
- Department of Dermatology, Venereology and Allergology, University of Leipzig Medical Center, Leipzig, Germany
| | | | | | | | | | | |
Collapse
|
41
|
Zalaudek I, Piana S, Moscarella E, Longo C, Zendri E, Castagnetti F, Pellacani G, Lallas A, Argenziano G. Morphologic grading and treatment of facial actinic keratosis. Clin Dermatol 2014; 32:80-7. [PMID: 24314380 DOI: 10.1016/j.clindermatol.2013.05.028] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Actinic keratoses (AKs) represent the earliest stage in the development of squamous cell carcinoma (SCC) and represent important biomarkers for individuals at risk for development of invasive SCC. Based on clinical morphology, AK can be subdivided into three different grades, which correspond to specific dermatoscopic, reflectance confocal microscopic, and histopathologic substrates. Given the risk for potential progression toward invasive SCC, AK should be treated at the earliest stage. A wide range of minimal destructive or topical therapies is available for the treatment of AK. The choice of treatment depends on the number, size, clinical grading, duration, and location of lesions, patient's compliance, general health conditions, and cosmetic outcome. Treatment can be divided into lesion-directed and field-directed therapies. Lesion-directed treatment focuses on the treatment of single lesions, whereas field-directed treatment aims to eliminate both clinically visible and subclinical lesions within the field of actinic damage (concept of field cancerization). Noninvasive techniques such as dermoscopy and reflectance confocal microscopy can be helpful in identifying AK potentially progressing toward SCC, as well as in the selection of the adequate treatment and monitoring of the treatment outcome.
Collapse
Affiliation(s)
- Iris Zalaudek
- Skin Cancer Unit, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Viale Risorgimento 80, 42100 Reggio Emilia, Italy; Department of Dermatology, Medical University of Graz Auenbruggerplatz 8; 8046 Graz, Austria.
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Anzai S, Anan T, Kai Y, Goto M, Arakawa S, Shimizu F, Hatano Y, Sato H, Shibuya H, Katagiri K, Fujiwara S. Skin Cancer Screening on a Fishing Island and in an Inland Agricultural Area of Japan. J Dermatol 2014; 32:875-82. [PMID: 16361747 DOI: 10.1111/j.1346-8138.2005.tb00864.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2005] [Accepted: 06/24/2005] [Indexed: 11/27/2022]
Abstract
We performed skin cancer screening from 2000 to 2004 at two locations in Japan's Oita Prefecture: Himeshima, a small fishing island, and Naoiri, an inland agricultural area. We found 108 and 21 cases of AK in Himeshima and Naoiri, respectively. None of the AKs transformed into SCC, and 21.7% of the AKs underwent spontaneous remission during our observation period. The prevalence and incidence of AK in Himeshima were five times higher than in Naoiri: 1,399 and 826 per 100,000 population, respectively, in the fishing village, vs. 261 and 164 in the agricultural community. Seven and three cases of BCC were observed in Himeshima and Naoiri, respectively. There were two cases of SCC in Himeshima. The highest risk ratio of skin types I to III was 9.2 in Himeshima. Although people engaged in outdoor occupations are thought to be more prone to skin cancer and precancerous skin lesions, our results suggested different potentials for AK in people engaged in different outdoor occupations.
Collapse
Affiliation(s)
- Saburo Anzai
- Department of Dermatology, Faculty of Medicine, Oita University, Oita, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Schmitt AR, Bordeaux JS. Solar keratoses: photodynamic therapy, cryotherapy, 5-fluorouracil, imiquimod, diclofenac, or what? Facts and controversies. Clin Dermatol 2014; 31:712-7. [PMID: 24160275 DOI: 10.1016/j.clindermatol.2013.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Actinic keratosis is a common dermatologic condition that may regress, remain stable, or progress to squamous cell carcinoma. Some question whether all actinic keratoses should be routinely treated, whereas others contend that the unpredictable natural history of this disease necessitates treatment to prevent malignant transformation. Available treatments include photodynamic therapy, cryotherapy, 5-fluorouracil, imiquimod, and diclofenac. Each of these options has its advantages and disadvantages, although they all have a place in the management of actinic keratosis. An overview of these treatment modalities is presented, as are the controversies surrounding the treatment of actinic keratosis.
Collapse
Affiliation(s)
- Adam R Schmitt
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | |
Collapse
|
44
|
Werner RN, Sammain A, Erdmann R, Hartmann V, Stockfleth E, Nast A. The natural history of actinic keratosis: a systematic review. Br J Dermatol 2014; 169:502-18. [PMID: 23647091 DOI: 10.1111/bjd.12420] [Citation(s) in RCA: 206] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2013] [Indexed: 11/29/2022]
Abstract
Knowledge about the development of untreated actinic keratosis (AK) and risk of progression into squamous cell carcinoma (SCC) is important. Therefore, we set out to synthesize primary data on the natural history of AK. We carried out a systematic literature search (Medline, Medline in Process, Embase, Cochrane) of studies on the natural course of AK, regarding (i) progression and regression rates per lesion-year, (ii) changes in total lesion counts over time, and (iii) spontaneous field regression and recurrence rates, taking into account studies on participants without immunosuppression and history of skin cancer, immunosuppressed patients and participants with a history of skin cancer and sunscreen use. Twenty-four eligible studies were identified providing data on at least one of the outcomes. Progression rates of AK to SCC ranged from 0% to 0·075% per lesion-year, with a risk of up to 0·53% per lesion in patients with prior history of nonmelanoma skin cancer. Rates of regression of single lesions ranged between 15% and 63% after 1 year. The data available on recurrence rates of single lesions 1 year after regression indicate a recurrence rate of 15-53%. Data on the relative change of total AK count over time are heterogeneous, and range from -53% to +99·1%. Spontaneous complete field regression rates range from 0% to 21%, with recurrences in 57%. In general, the available data are limited. Important methodological limitations apply. Currently, no reliable estimates concerning the frequency of AK developing into invasive carcinoma can be given, and further studies are needed.
Collapse
Affiliation(s)
- R N Werner
- Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz, 1, 10117, Berlin, Germany
| | | | | | | | | | | |
Collapse
|
45
|
Ferrándiz C, Fonseca-Capdevila E, García-Diez A, Guillén-Barona C, Belinchón-Romero I, Redondo-Bellón P, Moreno-Giménez J, Senán R. Adaptación española de la Guía europea para la evaluación y tratamiento de la queratosis actínica. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.ad.2013.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
46
|
Ferrándiz C, Fonseca-Capdevila E, García-Diez A, Guillén-Barona C, Belinchón-Romero I, Redondo-Bellón P, Moreno-Giménez JC, Senán R. Spanish adaptation of the European guidelines for the evaluation and treatment of actinic keratosis. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:378-93. [PMID: 24725552 DOI: 10.1016/j.adengl.2013.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 11/29/2013] [Indexed: 11/19/2022] Open
Abstract
Current trends in our setting indicate that the prevalence of actinic keratosis and similar diseases will increase in coming years and impose a greater burden on health care resources. A long list of clinical features must be taken into account when approaching the treatment of actinic keratosis. Until recently, therapeutic approaches focused solely on ablative procedures and the treatment of individual lesions and did not take into account areas of field cancerization. Now that the therapeutic arsenal has grown, standardized criteria are needed to guide the optimal choice of treatment for each patient. The elaboration of evidence-based consensus recommendations for the diagnosis and treatment of actinic keratosis generates knowledge that will help clinicians to deliver the highest level of care possible, standardizing decision-making processes and enhancing awareness among all the health professionals involved in the care pathway.
Collapse
Affiliation(s)
- C Ferrándiz
- Servicio de Dermatología, Hospital Universitario Germans Trías i Pujol, Badalona, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - E Fonseca-Capdevila
- Servicio de Dermatología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - A García-Diez
- Servicio de Dermatología, Hospital Universitario de la Princesa, Madrid, Spain
| | - C Guillén-Barona
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain
| | - I Belinchón-Romero
- Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, Spain
| | - P Redondo-Bellón
- Servicio de Dermatología, Clínica Universidad de Navarra, Pamplona, Spain
| | - J C Moreno-Giménez
- Servicio de Dermatología, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - R Senán
- Centro de Atención Primaria El Clot, Barcelona, Spain
| |
Collapse
|
47
|
Abstract
Actinic keratoses (AKs) are common skin lesions heralding an increased risk of developing squamous cell carcinoma (SCC) and other skin malignancies, arising principally due to excessive ultraviolet (UV) exposure. They are predominantly found in fair-skinned individuals, and increasingly, are a problem of the immunosuppressed. AKs may regress spontaneously, remain stable or transform to invasive SCC. The risk of SCC increases for those with more than 5 AKs, and the majority of SCCs arise from AKs. The main mechanisms of AK formation are inflammation, oxidative stress, immunosuppression, impaired apoptosis, mutagenesis, dysregulation of cell growth and proliferation, and tissue remodeling. Human papilloma virus has also been implicated in the formation of some AKs. Understanding these mechanisms guides the rationale behind the current available treatments for AKs. One of the main principles underpinning the management of AKs is that of field cancerization. Wide areas of skin are exposed to increasing amounts of UV light and other environmental insults as we age. This is especially true for the head, neck and forearms. These insults do not target only the skin where individual lesions develop, but also large areas where crops of AKs may appear. The skin between lesions is exposed to the same insults and is likely to contain as-yet undetectable preclinical lesions or areas of dysplastic cells. The whole affected area is known as the ‘field’. Management is therefore divided into lesion-directed and field-directed therapies. Current therapies include lesion-directed cryotherapy and/or excision, and topical field-directed creams: 5-fluorouracil, imiquimod, diclofenac, photodynamic therapy and ingenol mebutate. Combining lesion- and field-directed therapies has yielded good results and several novel therapies are under investigation. Treatment is variable and tailored to the individual making a gold standard management algorithm difficult to design. This literature review article aims to describe the rationale behind the best available therapies for AKs in light of current understanding of pathophysiology and epidemiology. A PubMed and MEDLINE search of literature was performed between January 1, 2000 and September 18, 2013. Where appropriate, articles published prior to this have been referenced. This is not a systematic review or meta-analysis, but aims to highlight the most up to date understanding of AK disease and its management.
Collapse
|
48
|
Dréno B, Amici JM, Basset-Seguin N, Cribier B, Claudel JP, Richard MA. Management of actinic keratosis: a practical report and treatment algorithm from AKTeam™ expert clinicians. J Eur Acad Dermatol Venereol 2014; 28:1141-9. [PMID: 24612407 DOI: 10.1111/jdv.12434] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 01/31/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Actinic keratoses (AK) are common photo-induced cutaneous lesions that may progress to invasive squamous-cell carcinoma and serve as a risk marker for skin cancer. Although numerous studies present the various therapeutic options for AK, publications that can be used to pragmatically guide dermatologists in their daily practice are limited. National and international guidelines have been published, however, they are based on clinical trials with highly selected patient populations and do not always capture the range of patients seen in everyday practice. OBJECTIVE The objective of this expert panel of French dermatologists was to present an analysis of AK geared towards everyday practice, to express an informed opinion about most recent treatments, and to propose a treatment algorithm for AK for daily practice in France. METHODS Over a 12 month period, six expert dermatologists in the field of AK (AKTeam(TM) expert panel) met regularly to formulate an opinion about treatment in everyday practice compared with the analysis of the literature and guidelines published since 1990. RESULTS Definitions, terminology, diagnosis and risk factors were summarized. Data from the literature and current practices related to the initial evaluation, indications for biopsy, therapeutic indications, therapeutic options and effectiveness, monitoring and prevention were discussed. A pragmatic treatment algorithm was formalized according to current data available. This practical algorithm distinguishes between different clinical situations depending on the number of AK, their hyperkeratotic or suspicious nature, and includes cryotherapy, curettage-electrocoagulation, 5% 5-fluorouracil, 3% diclofenac sodium, 5% imiquimod, 150 and 500 μg/g ingenol mebutate, lasers, photodynamic therapy and surgery. CONCLUSION This up-to-date expert opinions about AK and its treatment provide a management strategy and practical treatment algorithm for AK for French dermatologists to use.
Collapse
Affiliation(s)
- B Dréno
- Department of Dermato cancerology, University Hospital Hotel Dieu, Nantes, France
| | | | | | | | | | | | | |
Collapse
|
49
|
Iannacone MR, Hughes MCB, Green AC. Effects of sunscreen on skin cancer and photoaging. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2014; 30:55-61. [DOI: 10.1111/phpp.12109] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Michelle R. Iannacone
- Cancer and Population Studies Group; Royal Brisbane Hospital; QIMR Berghofer Medical Research Institute; Brisbane QLD Australia
| | - Maria Celia B. Hughes
- Cancer and Population Studies Group; Royal Brisbane Hospital; QIMR Berghofer Medical Research Institute; Brisbane QLD Australia
| | - Adèle C. Green
- Cancer and Population Studies Group; Royal Brisbane Hospital; QIMR Berghofer Medical Research Institute; Brisbane QLD Australia
- Manchester Academic Health Science Center; Institute of Inflammation and Repair; University of Manchester; Manchester UK
| |
Collapse
|
50
|
Lee K, Lew R, Weinstock M. Improvement in precision of counting actinic keratoses. Br J Dermatol 2014; 170:188-91. [DOI: 10.1111/bjd.12629] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2013] [Indexed: 11/30/2022]
Affiliation(s)
- K.C. Lee
- Dermatoepidemiology Unit; VA Medical Center; Providence RI U.S.A
- Department of Dermatology; Brown University; Providence RI U.S.A
| | - R. Lew
- Department of Veterans Affairs; VA Medical Center; Boston MA U.S.A
| | - M.A. Weinstock
- Dermatoepidemiology Unit; VA Medical Center; Providence RI U.S.A
- Department of Dermatology; Brown University; Providence RI U.S.A
- Department of Epidemiology; Brown University; Providence RI U.S.A
| | | |
Collapse
|