Management of actinic keratosis at specific body sites in patients at high risk of carcinoma lesions: expert consensus from the AKTeam™ of expert clinicians

Management of actinic keratosis at specific body sites in patients at high risk of carcinoma... Actinic keratoses (AK) arise on sun‐exposed regions of the skin. If left untreated, AK may progress to invasive squamous cell carcinoma (SCC), although the rate of progression is low. A practical treatment algorithm for the treatment of AK in standard situations has been published by the AKTeam™ expert panel. However, management of particular situations of AK with increasing/higher carcinoma risk or AK progressing into carcinomas with increased aggressiveness due to their anatomical location (risky areas), or in patients with an increased risk of SCC requires further discussion. These include AK on the dorsal hands, forearms, legs, periorbital region, eyelids, ears, or lips, and organ transplant recipients, patients undergoing treatment with carcinogenic agents and patients with chronic lymphocytic leukaemia. The main objective was to propose therapeutic strategies for the treatment of AK located in risky areas and in patients with more invasive/aggressive lesions and a higher risk of progression to SCC. A systematic review of the literature was initially performed, and results were discussed by the experts to propose best management practices in specific situations. Finally, adapted management strategies for AK occurring in risky areas and in high‐risk patients are presented, taking into account the experts’ own clinical experience and current guidelines. In most of these ‘at‐risk’ situations, patients can be treated according to the AKTeam™ treatment algorithm. Difficult‐to‐treat lesions should be treated more aggressively due to their higher risk of transformation. For patients with skin that is highly susceptible to actinic damage, monitoring and sun protection strategies are mandatory, and patients should undergo more regular follow‐up. Further assessment of newer therapies in clinical trials is necessary to determine optimal treatment conditions. This expert consensus provides guidance for the management of AK in risky body sites and in patients with an increasing/higher risk for SCCs. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of the European Academy of Dermatology & Venereology Wiley

Management of actinic keratosis at specific body sites in patients at high risk of carcinoma lesions: expert consensus from the AKTeam™ of expert clinicians

8 pages
Read Article

Loading next page...
 
/lp/wiley/management-of-actinic-keratosis-at-specific-body-sites-in-patients-at-xOdx7s0Qc3
Publisher
Wiley Subscription Services, Inc., A Wiley Company
Copyright
Copyright © 2018 European Academy of Dermatology and Venereology
ISSN
0926-9959
eISSN
1468-3083
D.O.I.
10.1111/jdv.14753
Publisher site
See Article on Publisher Site

Abstract

Actinic keratoses (AK) arise on sun‐exposed regions of the skin. If left untreated, AK may progress to invasive squamous cell carcinoma (SCC), although the rate of progression is low. A practical treatment algorithm for the treatment of AK in standard situations has been published by the AKTeam™ expert panel. However, management of particular situations of AK with increasing/higher carcinoma risk or AK progressing into carcinomas with increased aggressiveness due to their anatomical location (risky areas), or in patients with an increased risk of SCC requires further discussion. These include AK on the dorsal hands, forearms, legs, periorbital region, eyelids, ears, or lips, and organ transplant recipients, patients undergoing treatment with carcinogenic agents and patients with chronic lymphocytic leukaemia. The main objective was to propose therapeutic strategies for the treatment of AK located in risky areas and in patients with more invasive/aggressive lesions and a higher risk of progression to SCC. A systematic review of the literature was initially performed, and results were discussed by the experts to propose best management practices in specific situations. Finally, adapted management strategies for AK occurring in risky areas and in high‐risk patients are presented, taking into account the experts’ own clinical experience and current guidelines. In most of these ‘at‐risk’ situations, patients can be treated according to the AKTeam™ treatment algorithm. Difficult‐to‐treat lesions should be treated more aggressively due to their higher risk of transformation. For patients with skin that is highly susceptible to actinic damage, monitoring and sun protection strategies are mandatory, and patients should undergo more regular follow‐up. Further assessment of newer therapies in clinical trials is necessary to determine optimal treatment conditions. This expert consensus provides guidance for the management of AK in risky body sites and in patients with an increasing/higher risk for SCCs.

Journal

Journal of the European Academy of Dermatology & Venereology – Wiley

Published: Jan 1, 2018

References

  • The natural history of actinic keratosis: a systematic review
    Werner, RN; Sammain, A; Erdmann, R; Hartmann, V; Stockfleth, E; Nast, A
  • Management of actinic keratosis: a practical report and treatment algorithm from AKTeam expert clinicians
    Dreno, B; Amici, JM; Basset‐Seguin, N
  • French Dermatology Recommendations Association (aRED). Guidelines for the diagnosis and treatment of cutaneous squamous cell carcinoma and precursor lesions
    Bonerandi, JJ; Beauvillain, C; Caquant, L
  • Photodynamic therapy using intense pulsed light for treating actinic keratoses and photoaged skin of the dorsal hands: a randomized placebo‐controlled study
    Kohl, E; Popp, C; Zeman, F
  • An investigator‐initiated study to assess the safety and efficacy of ingenol mebutate 0.05% gel when used after cryosurgery in the treatment of hypertrophic actinic keratosis on dorsal hands
    Hashim, PW; Nia, JK; Singer, S; Goldenberg, G
  • An investigator‐initiated study to assess the safety and efficacy of imiquimod 3.75% cream when used after cryotherapy in the treatment of hypertrophic actinic keratoses on dorsal hands and forearms
    Goldenberg, G; Linkner, RV; Singer, G; Frankel, A
  • Low‐dose 5‐fluorouracil in combination with salicylic acid for the treatment of actinic keratoses on the hands and/or forearms ‐ results of a non‐interventional study
    Reinhold, U; Hadshiew, I; Melzer, A; Prechtl, A
  • Body‐site distribution of skin cancer, pre‐malignant and common benign pigmented lesions excised in general practice
    Youl, PH; Janda, M; Aitken, JF; Del Mar, CB; Whiteman, DC; Baade, PD
  • Management of periocular actinic keratosis: a review of practice patterns among ophthalmic plastic surgeons
    Lagler, CN; Freitag, SK
  • Melanotic and non‐melanotic malignancies of the face and external ear ‐ A review of current treatment concepts and future options
    Kolk, A; Wolff, KD; Smeets, R; Kesting, M; Hein, R; Eckert, AW
  • Photodynamic therapy as a response to the challenge of treating actinic keratosis in the eyelid area
    Toledo‐Alberola, F; Belinchon‐Romero, I; Guijarro‐Llorca, J; Albares‐Tendero, P
  • Topical 5‐fluorouracil for the treatment of periocular actinic keratosis and low‐grade squamous malignancy
    Couch, SM; Custer, PL
  • Topical diclofenac gel for the management of periocular actinic keratosis
    Batra, R; Sundararajan, S; Sandramouli, S
  • The use of imiquimod in the treatment of periocular tumours
    Ross, AH; Kennedy, CT; Collins, C; Harrad, RA
  • Analysis of risk factors determining prognosis of cutaneous squamous‐cell carcinoma: a prospective study
    Brantsch, KD; Meisner, C; Schonfisch, B
  • Potentially malignant oral lesions: clinicopathological correlations
    Maia, HC; Pinto, NA; Pereira Jdos, S; De Medeiros, AM; Da Silveira, EJ; Miguel, MC
  • Clinicopathological profile and management of 161 cases of actinic cheilitis
    Lopes, ML; Silva Junior, FL; Lima, KC; Oliveira, PT; Silveira, EJ
  • Management of actinic cheilitis using ingenol mebutate gel: a report of seven cases
    Florez, A; Batalla, A; Torre, C
  • Ingenol mebutate gel treatment for actinic cheilitis: report of four cases
    Barrado Solis, N; Moles Poveda, P; Lloret Ruiz, C
  • Italian Group For Photodynamic T. A retrospective analysis of real‐life practice of off‐label photodynamic therapy using methyl aminolevulinate (MAL‐PDT) in 20 Italian dermatology departments. Part 2: oncologic and infectious indications
    Calzavara‐Pinton, PG; Rossi, MT; Sala, R
  • Methyl‐aminolevulinate photodynamic therapy for the treatment of actinic cheilitis: a retrospective evaluation of 29 patients
    Fai, D; Romano, I; Cassano, N; Vena, GA
  • Photodynamic therapy in actinic cheilitis: clinical and anatomopathological evaluation of 19 patients
    Ribeiro, CF; Souza, FH; Jordao, JM
  • Efficacy of ablative fractional laser‐assisted photodynamic therapy for the treatment of actinic cheilitis: 12‐month follow‐up results of a prospective, randomized, comparative trial
    Choi, SH; Kim, KH; Song, KH
  • Erbium laser resurfacing for actinic cheilitis
    Cohen, JL
  • Photodynamic therapy for actinic cheilitis: a systematic review
    Yazdani Abyaneh, MA; Falto‐Aizpurua, L; Griffith, RD; Nouri, K
  • Ablative fractional laser assisted photodynamic therapy for the treatment of actinic cheilitis
    Dinani, N; Topham, E; Derrick, E; Atkinson, L
  • Skin cancer in solid organ transplant recipients: advances in therapy and management: part I. Epidemiology of skin cancer in solid organ transplant recipients
    O'Reilly Zwald, F; Brown, M
  • Skin cancers after organ transplantation
    Euvrard, S; Kanitakis, J; Claudy, A
  • Skin cancer in solid organ transplant recipients: advances in therapy and management: part II. Management of skin cancer in solid organ transplant recipients
    O'Reilly Zwald, F; Brown, M
  • Actinic keratosis‐related signs predictive of squamous cell carcinoma in renal transplant recipients: a nested case‐control study
    Jiyad, Z; O'Rourke, P; Soyer, HP; Green, AC
  • Actinic keratoses, actinic field change and associations with squamous cell carcinoma in renal transplant recipients in Manchester, UK
    Wallingford, SC; Russell, SA; Vail, A; Proby, CM; Lear, JT; Green, AC
  • Photodynamic therapy for actinic keratosis in organ transplant patients
    Basset‐Seguin, N; Baumann Conzett, K; Gerritsen, MJ
  • Intensified fractional CO2 laser‐assisted photodynamic therapy vs. laser alone for organ transplant recipients with multiple actinic keratoses and wart‐like lesions: a randomized half‐side comparative trial on dorsal hands
    Helsing, P; Togsverd‐Bo, K; Veierod, MB; Mork, G; Haedersdal, M
  • Combination of ablative fractional laser and daylight‐mediated photodynamic therapy for actinic keratosis in organ transplant recipients ‐ a randomized controlled trial
    Togsverd‐Bo, K; Lei, U; Erlendsson, AM
  • Application of photodynamic therapy combined with pre‐illumination microneedling in the treatment of actinic keratosis in organ transplant recipients
    Bencini, PL; Galimberti, MG; Pellacani, G; Longo, C
  • Sequential curettage, 5‐fluorouracil, and photodynamic therapy for field cancerization of the scalp and face in solid organ transplant recipients
    Jambusaria‐Pahlajani, A; Ortman, S; Schmults, CD; Liang, C
  • Risk of malignancies in patients with inflammatory bowel disease treated with thiopurines or anti‐TNF alpha antibodies
    Beigel, F; Steinborn, A; Schnitzler, F
  • Azathioprine and risk of skin cancer in organ transplant recipients: systematic review and meta‐analysis
    Jiyad, Z; Olsen, CM; Burke, MT; Isbel, NM; Green, AC
  • Risk of non‐melanoma skin cancer in myasthenia patients treated with azathioprine
    Pedersen, EG; Pottegard, A; Hallas, J
  • Increased incidence of squamous cell carcinoma of the skin after long‐term treatment with azathioprine in patients with auto‐immune inflammatory rheumatic diseases
    Reek, JM; Lumig, PP; Janssen, M
  • Multiple skin tumors on light‐exposed areas during long‐term treatment with hydroxyurea
    Papi, M; Didona, B; DePita, O
  • Multiple actinic keratosis and skin tumors secondary to hydroxyurea treatment
    Salmon‐Ehr, V; Grosieux, C; Potron, G; Kalis, B
  • The cutaneous side‐effects of hydroxyurea
    Young, HS; Khan, AS; Kendra, JR; Coulson, IH
  • Hydroxyurea‐associated dermatomyositis‐like eruption demonstrating abnormal epidermal p53 expression: a potential premalignant manifestation of chronic hydroxyurea and UV radiation exposure
    Kalajian, AH; Cely, SJ; Malone, JC; Burruss, JB; Callen, JP
  • Muco‐cutaneous retinoid‐effects and facial erythema related to the novel triazole antifungal agent voriconazole
    Denning, DW; Griffiths, CE
  • Chronic phototoxicity and aggressive squamous cell carcinoma of the skin in children and adults during treatment with voriconazole
    Cowen, EW; Nguyen, JC; Miller, DD
  • Melanoma associated with long‐term voriconazole therapy: a new manifestation of chronic photosensitivity
    Miller, DD; Cowen, EW; Nguyen, JC; McCalmont, TH; Fox, LP
  • Risk of cancer in psoriasis: a systematic review and meta‐analysis of epidemiological studies
    Pouplard, C; Brenaut, E; Horreau, C
  • Carcinogenic risks of psoralen UV‐A therapy and narrowband UV‐B therapy in chronic plaque psoriasis: a systematic literature review
    Archier, E; Devaux, S; Castela, E
  • The increased risk of skin cancer is persistent after discontinuation of psoralen+ultraviolet A: a cohort study
    Nijsten, TE; Stern, RS
  • Markedly reduced incidence of melanoma and nonmelanoma skin cancer in a nonconcurrent cohort of 10,040 patients with vitiligo
    Paradisi, A; Tabolli, S; Didona, B; Sobrino, L; Russo, N; Abeni, D
  • Decreased risk of melanoma and nonmelanoma skin cancer in patients with vitiligo: a survey among 1307 patients and their partners
    Teulings, HE; Overkamp, M; Ceylan, E
  • Actinic damage and skin cancer in albinos in northern Tanzania: findings in 164 patients enrolled in an outreach skin care program
    Lookingbill, DP; Lookingbill, GL; Leppard, B
  • Incidence of cutaneous squamous cell carcinoma in a New Zealand population of chronic lymphocytic leukaemia patients
    Hock, BD; McIntosh, ND; McKenzie, JL; Pearson, JF; Simcock, JW; MacPherson, SA
  • Increased metastasis and mortality from cutaneous squamous cell carcinoma in patients with chronic lymphocytic leukemia
    Mehrany, K; Weenig, RH; Lee, KK; Pittelkow, MR; Otley, CC
  • Aggressive behavior of cutaneous squamous cell carcinoma in patients with chronic lymphocytic leukemia
    Tomaszewski, JM; Gavriel, H; Link, E; Boodhun, S; Sizeland, A; Corry, J
  • Cutaneous findings in chronic lymphocytic leukaemia
    Agnew, KL; Ruchlemer, R; Catovsky, D; Matutes, E; Bunker, CB

You’re reading a free preview. Subscribe to read the entire article.

Try 2 weeks free now

DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 12 million articles from more than
10,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

or browse the journals available

Unlimited reading

Read as many articles as you need. Full articles with original layout, charts and figures. Read online, from anywhere.

Stay up to date

Keep up with your field with Personalized Recommendations and Follow Journals to get automatic updates.

Organize your research

It’s easy to organize your research with our built-in tools.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

Monthly Plan

  • Read unlimited articles
  • Personalized recommendations
  • No expiration
  • Print 20 pages per month
  • 20% off on PDF purchases
  • Organize your research
  • Get updates on your journals and topic searches

$49/month

Start Free Trial

14-day Free Trial

Best Deal — 39% off

Annual Plan

  • All the features of the Professional Plan, but for 39% off!
  • Billed annually
  • No expiration
  • For the normal price of 10 articles elsewhere, you get one full year of unlimited access to articles.

$588

$360/year

billed annually
Start Free Trial

14-day Free Trial

Interested in DeepDyve for your group?
Try 2 weeks free now