Actinic keratosis: correlation between clinical and histological classification systems

Schmitz, Lutz; Kahl, Philip; Majores, Michael; Bierhoff, E.; Stockfleth, Eggert; Dirschka, Thomas

doi:10.1111/jdv.13626

Cited by 100 publications

(131 citation statements)

References 31 publications

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“…In other words, it is not possible to predict which AKs will progress, regardless of the grade. Moreover, clinical classifications do not correlate accurately with histology . Thus, the usefulness of classifying AKs into low‐ and high‐risk lesions is questionable and should be further investigated .…”

Section: From Ak To Iscc: Is It Possible To Predict Which Aks Will Prmentioning

confidence: 99%

From actinic keratosis to squamous cell carcinoma: pathophysiology revisited

Figueras

2017

Acad Dermatol Venereol

141

115

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The precursor of most cutaneous invasive squamous cell carcinomas (iSCCs) is intraepithelial UV-induced damage, known as field cancerization, which can eventually transform into actinic keratosis (AK). Although AK is the most common precursor of iSCC, many AKs will either persist in the same stage or regress, while only a few will progress into iSCC. Nevertheless, because the progression of individual AKs cannot be predicted, it has been proposed that all AKs, regardless of the grade, should be carefully monitored and appropriately treated in clinical practice. Modern imaging techniques such as dermatoscopy, reflectance confocal microscopy (RCM) and high-definition optical coherence tomography (HD-OCT) may have potential to monitor the evolution of actinic field damage. Dermatoscopy can be used to differentiate between AK, intraepidermal carcinoma (IEC) and SCC which may help clinicians to diagnose in situ or invasive lesions at an earlier stage. HD-OCT and RCM can be used to detect cellular and histological changes characteristic of subclinical lesions, allowing visualization of previously invisible lesions. As development of invasive AK directly from the cancer field cannot be ruled out, the ideal treatment should be able to eradicate AK lesions and reverse the underlying field cancerization.

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Section: From Ak To Iscc: Is It Possible To Predict Which Aks Will Prmentioning

confidence: 99%

From actinic keratosis to squamous cell carcinoma: pathophysiology revisited

Figueras

2017

Acad Dermatol Venereol

141

115

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“…From a pharmaceutical perspective, besides selectivity, also epidermal penetration and stability of the prodrug and its vehicle determine the efficacy of ALA-PDT [19].…”

Section: Photodynamic Therapy For Actinic Keratosismentioning

confidence: 99%

“…This method analyzes the extent of atypical keratinocytes (AK I-III) [18]. 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].…”

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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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“…In the past, most AK studies excluded hyperkeratotic lesions assuming a higher risk of progression into invasive carcinoma. However, a recent study has shown that it is not possible to draw a correlation from clinical appearance to histology [7]. Furthermore, another study revealed that the thickness of AKs does not predict its dysplastic severity and thus its aggressiveness [6].…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies show that the thickness of AK does not predict its degree of dysplasia or correlate with established histological grading systems [6, 7]. Furthermore, a lesion-based classification scheme does not adequately represent the whole area affected by AK.…”

Section: Introductionmentioning

confidence: 99%

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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Actinic keratosis: correlation between clinical and histological classification systems

Cited by 100 publications

References 31 publications

From actinic keratosis to squamous cell carcinoma: pathophysiology revisited

From actinic keratosis to squamous cell carcinoma: pathophysiology revisited

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

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