A proposed scoring system for assessing the severity of actinic keratosis on the head: actinic keratosis area and severity index

Dirschka, Thomas; Pellacani, Giovanni; Micali, Giuseppe; Malvehy, Josep; Stratigos, Alexander J.; Casari, Alice; Schmitz, Lutz; Gupta, Girish

doi:10.1111/jdv.14267

Cited by 79 publications

(100 citation statements)

References 26 publications

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“…The two systems have recently been shown not to correlate [19]. An objective assessment of AKs for scoring their severity on the head has been developed and is described in the actinic keratosis and severity index [20]. This new assessment tool could be useful for AK classification and management in dermatological practice.…”

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confidence: 99%

A review of BF-200 ALA for the photodynamic treatment of mild-to-moderate actinic keratosis

Reinhold¹

2017

Future Oncol.

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BF-200 ALA is a combination of a nanoscale-lipid vesicle formulation and the prodrug 5-aminolevulinic acid (5-ALA). The nanoemulsion stabilizes the prodrug and enhances its penetration through the stratum corneum. It has shown excellent therapeutic results in both lesion and field-directed photodynamic therapy of actinic keratosis (AK). AK is an early form of epidermal neoplasia and a precursor of invasive cutaneous squamous cell carcinoma. It is characterized by the combination of visible neoplastic lesions and surrounding tissue also harboring tumorigenic UV-induced mutations: a concept called field cancerization. A selective, field-directed treatment is ideal to meet the requirements of field change. Here, we review the clinical data on BF-200 ALA for AK along with a summary of molecular mechanisms and future perspectives. Actinic keratosis (AK), also known as solar keratosis, is caused by chronic exposure to sunlight or other ultraviolet light sources [1,2] and may progress to invasive squamous cell carcinoma (SCC) [3]. It is the most common lesion with malignant potential to arise on the skin. AK is mostly seen in Caucasians in skin areas that have extensive sun exposure throughout their lives [4]. Epidemiological data show a high occurrence rate of AK. Regions with higher ultraviolet exposure have a higher prevalence of AK. For the USA, the prevalence was estimated to range from 11 to 26%, while in Australia it ranged from 40 to 60%. In Europe, a prevalence of 15% in men and 6% in women has been documented [5]. Over the age of 70 years, 34% of men and 18% of women were found to have actinic keratotic lesions [6]. Next to fair skin type, an advanced age and lifelong sun exposure immunosuppression/-deficiency plays another important risk factor [5].Mostly, AK develops slowly and early in the disease process, they may disappear only to reappear later. Recurrence of the disease may include partial elimination of the initial lesion, subclinical lesion progression to visible status, or development of new lesions [7]. On top of this, an AK may progress to invasive SCC, the second-most common form of skin cancer [8,9]. The actual percentage of progress to invasive SCC remains unknown, and estimates vary from 5 to 20% within 10 to 25 years with reported annual transformation rates varying greatly from as low as 0.25% to as high as 16% [10]. The regression rate for a single untreated lesion is 15 to 63% after a year; recurrence rates range from 15 to 53% [11]. In general patients develop multiple AKs in one area and predicting which course each individual lesion will follow is impossible. Nonetheless, AK lesions are reliable markers for patients who are most predisposed to developing invasive SCC [4,[12][13].AK lesions typically appear in areas most frequently exposed to the sun such as the face, back of the hands, or bald scalp; 75% of lesions are found on the head, neck and forearms [14]. The lesions vary in appearance as well as size and can include erythematous scaly macules, rough pigmented patches and hyperker...

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confidence: 99%

A review of BF-200 ALA for the photodynamic treatment of mild-to-moderate actinic keratosis

Reinhold¹

2017

Future Oncol.

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“…Besides disease monitoring, AKASI is a reproducible, standardized, and comparable assessment tool in clinical trials [8]. Commonly, the primary endpoint in new AK treatment evaluation is complete clearance rates [13].…”

Section: Discussionmentioning

confidence: 99%

“…In the group of eligible patients, these scores were performed by 4 investigators (M.H.S., R.K., J.S., L.S.). Assessment of AKASI has been described in detail previously [8]. Total AKASI of the head can range from 0 to 18 by adding the 4 subscores of the scalp, face, as well as right/left cheek, nose and chin.…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, a lesion-based classification scheme does not adequately represent the whole area affected by AK. To overcome this lack of reproducible assessment of field cancerization, the actinic keratosis area and severity index (AKASI) has recently been published [8]. This assessment tool provides an objective evaluation of field cancerization (AK severity) on the head.…”

Section: Introductionmentioning

confidence: 99%

“…It provides values which are independent of variable grading factors such as the size of the treated field and the number and characteristics of various AK lesions. Until now, AKASI has not been used to monitor treatment outcomes in routine clinical practice [8]. …”

Section: Introductionmentioning

confidence: 99%

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Diclofenac Sodium 3% in Hyaluronic Acid 2.5% Gel Significantly Diminishes the Actinic Keratosis Area and Severity Index

Schmitz

Gupta

Segert

et al. 2018

Skin Pharmacol Physiol

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Background/Aims: Actinic keratosis area and severity index (AKASI) is a new assessment tool to quantify the severity of actinic damage on the head. Thus far, it has not been evaluated in monitoring the efficacy of field-directed topical treatments in actinic keratosis (AK) in routine clinical practice. Thus, the aim of this study was to determine treatment outcomes by using AKASI 3 months after the initiation of topical application of diclofenac sodium 3% in hyaluronic acid 2.5% gel (DFS) in patients with AKs on the head. Methods: We performed a retrospective analysis of patients with AKs who had AKASI scores prior to and after treatment with DFS. Results: Of the 24 patients included, 20 (83.3%) showed an improvement in AKASI, 2 (8.3%) a stable AKASI, and 2 (8.3%) a worsening of AKASI after a median (interquartile range) follow-up period of 91.5 days (89.8–104.3). The median AKASI reduction was 31.4% (16.7–59.1). The Wilcoxon test showed significant differences (p = 0.0008) between baseline and posttreatment AKASI values. Conclusions: AKASI is an easy-to-use quantitative tool for assessing the treatment outcome of field-directed therapies. Field-directed therapies of AK should no longer be monitored by assessments based on lesion counts alone.

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Squamous Cell Carcinoma and its Precursors

Gupta,

Dirschka

2024

Rook's Textbook of Dermatology

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Squamous cell carcinoma (SCC) is the second commonest skin cancer and arises from epidermal keratinocytes or its appendages. The incidence of SCC has increased over the last five decades and is predicted to rise significantly over the next decade. SCC is predominantly a disease of white populations and is especially prevalent in this group in areas of high ambient sun exposure. Predisposing factors include male sex, immune suppression (particularly in those who are organ transplant recipients), sun exposure and advanced age. Precursor lesions such as actinic keratosis and Bowen disease may often be present and patients are more susceptible to developing other UV radiation‐induced skin cancers. SCC has a low rate of metastasis but this increases with SCCs displaying high‐risk features. All SCCs should undergo full clinicopathological correlation and high‐risk SCCs should be managed within a multidisciplinary setting with adequate tumour clearance as the main outcome.

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A proposed scoring system for assessing the severity of actinic keratosis on the head: actinic keratosis area and severity index

Abstract: Actinic keratosis area and severity index is proposed as a new quantitative tool for assessing AK severity on the head. It may be useful in the future evaluation of new AK treatments in clinical studies and the management of AK in daily practice.

Cited by 79 publications

References 26 publications

A review of BF-200 ALA for the photodynamic treatment of mild-to-moderate actinic keratosis

A review of BF-200 ALA for the photodynamic treatment of mild-to-moderate actinic keratosis

Diclofenac Sodium 3% in Hyaluronic Acid 2.5% Gel Significantly Diminishes the Actinic Keratosis Area and Severity Index

Squamous Cell Carcinoma and its Precursors

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