Italian expert consensus for the management of actinic keratosis in immunocompetent patients

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.

From actinic keratosis to squamous cell carcinoma: pathophysiology revisited

“…Although the estimated annual risk of progression from AK to iSCC for an individual lesion is believed to be small (0–0.53%), the cumulative risk for a patient with multiple AK lesions over time is substantial . Thus, due to the inability to predict which AKs will progress, current recommendations suggest that all AKs should be treated, although cost‐effectiveness of treatment and patient‐related factors are important when making treatment decisions . Therefore, subclinical damage and AK lesions, regardless of the grade, should be carefully monitored and appropriately treated.…”

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

“…13 Effective field treatments may have a therapeutic advantage over lesiondirected therapies in that they can also address subclinical and emerging AK lesions. [12][13][14][15][16] Furthermore, timely intervention with follow-up field treatment has been shown to provide sustained clearance of AK lesions. 12 Diclofenac sodium (DS) in a 3% topical gel formulation with 2Á5% hyaluronic acid is used to treat AK.…”

“…Lesion‐directed therapies, such as cryotherapy, target visible AK lesions but leave subclinical lesions in the cancerized field untreated, from which new lesions may emerge . Effective field treatments may have a therapeutic advantage over lesion‐directed therapies in that they can also address subclinical and emerging AK lesions . Furthermore, timely intervention with follow‐up field treatment has been shown to provide sustained clearance of AK lesions …”

Physician–patient communication and patient‐reported outcomes in the actinic keratosis treatment adherence initiative (AK‐TRAIN): a multicenter, prospective, real‐life study of treatment satisfaction, quality of life and adherence to topical field‐directed therapy for the treatment of actinic keratosis in Italy

“…Its prevalence ranges between 6% and 25% in European adults over 40 years of age . In Italy, 1.4% of the population self‐reported a diagnosis of AK anytime in the life course; however, such figure possibly underestimates the real prevalence of the disease, as it has been noted elsewhere …”

“…1,2 In Italy, 1.4% of the population self-reported a diagnosis of AK anytime in the life course 3 ; however, such figure possibly underestimates the real prevalence of the disease, as it has been noted elsewhere. 4 Whereas AK may have a self-limiting behaviour, its potential for cancer progression has been largely demonstrated 5-10 especially for patients with multiple lesions and field cancerization. 11 Therefore, AK often requires repeated treatments and may cause significant morbidity.…”