REVIEW ARTICLE
Management of actinic keratosis at specific body sites in
patients at high risk of carcinoma lesions: expert consensus
from the AKTeam
TM
of expert clinicians
M. A. Richard,
1,
* J. M. Amici,
2,3
N. Basset-Seguin,
4
J.P. Claudel,
5,6
B. Cribier,
7
B. Dreno
8
1
Dermatology Department, UMR 911, INSERM CRO2, “Center for Research in Biological Oncology and Oncophamacology”, Timone
Hospital, Public Hospitals of Marseille, Aix-Marseille University, Marseille, France
2
Private Office of dermatology Rive Droite, Cenon, France
3
Dermatology Department, H
^
opital Saint-Andre, Bordeaux, France
4
Dermatology Department, H
^
opital Saint-Louis, AP-HP, Paris, France
5
Private Office of Dermatology, Tours, France
6
Dermatology Department, CHU Clocheville, Tours, France
7
Dermatology Department, H
^
opitaux Universitaires de Strasbourg, Strasbourg, France
8
Department of Dermato cancerology, University Hospital Hotel Dieu, Nantes, France
*Correspondence: M. A. Richard. E-mail: marie-aleth.richard@ap-hm.fr
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 guid-
ance for the management of AK in risky body sites and in patients with an increasing/higher risk for SCCs.
Received: 30 August 2017; Accepted: 20 November 2017
Conflicts of interest
MAR: Investigator and Consultant for LEO Pharma;
JMA: Member of Board on Actinic Keratosis for LEO Pharma; Consultant for Galderma;
NB-S: Consultant for LEO Pharma, Galderma;
JPC: Member of Board on Actinic Keratosis for LEO Pharma;
BC: Board member for LEO, speaker for LEO, Av
ene, Roche Posay;
BD: Investigator and Consultant for LEO Pharma.
Funding sources
Funding was provided by a LEO Pharma institutional grant.
© 2017 European Academy of Dermatology and Venereology
JEADV
2018, 32, 339–346
DOI: 10.1111/jdv.14753
JEADV
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