Reliable Methods to Evaluate the Burden of Actinic Keratoses

Abstract

Dermatologists treat actinic keratoses to prevent non-melanoma skin cancer. Evaluation of actinic keratosis therapy depends on reliable measures of the lesions. The commonly used method of directly counting all visible lesions has been shown to be unreliable. We performed a prospective, single-blinded study to explore the reliability of body surface area involvement and direct counting of lesions measuring greater than 0.5 cm. Consecutively available subjects with >2% body surface area involvement of both upper extremities were recruited from the Albuquerque, NM Veterans Administration Dermatology Clinic upon their arrival. Blinded investigators evaluated 37 subjects during two visits, baseline and 2 weeks later, using both methods. Data were analyzed using the 26 pairs where evaluating physician was the same at both time points. Both methods correlated well when comparing the two time points. Our results did not change when we added the pairs where the evaluating physician differed in the two time points. Our study demonstrates that both methods are viable ways to evaluate actinic keratoses, even when the investigators differ at different time points, a practical matter in clinical trials. Our study provides a promising option to evaluate emerging new actinic keratoses therapies. However, given that the method was only tested on upper extremities of a veteran population, further testing must be performed in different anatomical locations and in non-veteran populations.

Oral acetylsalicylic acid and prevalence of actinic keratosis

“…[60][61][62] Our study presents some limitations as a result of a possible inaccuracy in the clinical diagnosis of AKs and also because the manual counting of lesions produces variable reproducibility. 14,63 Nevertheless, our results prove to be consistent with the data found in the literature and with the pathophysiology of the lesions. The differential quantification between erythematous and hypertrophic AKs also revealed elements that favor an approach by subgroups rather than the total counts of lesions used by other authors, mainly as long as we have no knowledge of the natural history and evolution of the genesis and transformation among those subtypes.…”

Counting Actinic Keratosis – Is Photographic Assessment a Reliable Alternative to Physical Examination in Clinical Trials?

“…In order to improve the reliability of AK counting, published studies have focused on various important factors, which include defining the diameter of individual AKs being counted (8,9), defining the total body surface area affected by AKs (8,9) and segmenting body sites for counting AKs (10).…”

Solanum incanum extract (SR-T100) induces human cutaneous squamous cell carcinoma apoptosis through modulating tumor necrosis factor receptor signaling pathway

“…The current consensus is to treat AK lesions whenever and wherever they are present. This practice would ensure best treatment outcome and lessen medical expenditures [18][19][20]. However, it should be noted that all current topical field therapies are associated with substantial pain, tissue destruction, scarring, pigmentary changes, inflammatory reactions, and frequent recurrence [21].…”

“…Although mortality from cutaneous SCC is rare, there is significant morbidity associated with the natural course of cancer development and failed treatment for SCC [18]. At present, prevention of SCC, or the treatment of its precursor lesions, AKs, is necessary and important [18], because not only of its high prevalence but also for the low per-patient cost and far more efficacious of its management [19]. It is not yet possible to determine which AK lesions will evolve into SCC.…”