S3 guideline for actinic keratosis and cutaneous squamous cell carcinoma – short version, part 1: diagnosis, interventions for actinic keratoses, care structures and quality‐of‐care indicators

Bubnoff

et al. 2020

JCM

Self Cite

Patient-centered motives and expectations of the treatment of actinic keratoses (AK) have received little attention until now. Hence, we aimed to profile and cluster treatment motivations and expectations among patients with AK in a nationwide multicenter, cross-sectional study including patients from 14 German skin cancer centers. Patients were asked to complete a self-administered questionnaire. Treatment motives and expectations towards AK management were measured on a visual analogue scale from 1–10. Specific patient profiles were investigated with subgroup and correlation analysis. Overall, 403 patients were included. The highest motivation values were obtained for the items “avoid transition to invasive squamous cell carcinoma” (mean ± standard deviation; 8.98 ± 1.46), “AK are considered precancerous lesions” (8.72 ± 1.34) and “treating physician recommends treatment” (8.10 ± 2.37; p < 0.0001). The highest expectation values were observed for the items “effective lesion clearance” (8.36 ± 1.99), “safety” (8.20 ± 2.03) and “treatment-related costs are covered by health insurance” (8.00 ± 2.41; p < 0.0001). Patients aged ≥77 years and those with ≥7 lesions were identified at high risk of not undergoing any treatment due to intrinsic and extrinsic motivation deficits. Heat mapping of correlation analysis revealed four clusters with distinct motivation and expectation profiles. This study provides a patient-based heuristic tool for a personalized treatment decision in patients with AK.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment Motivations and Expectations in Patients with Actinic Keratosis: A German-Wide Multicenter, Cross-Sectional Trial

Bubnoff

et al. 2020

JCM

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“…Data on the efficacy outcomes of interest were inconsistently reported. Results for lesion clearance were only available for ALA-PDT, demonstrating clearance of nearly 75% of all lesions, which is somewhat lower compared to previous pivotal trials [ 4 ]. Instead, the outcome participant complete clearance was reported in most of the included studies and revealed varying rates for the different interventions.…”

Section: Discussionmentioning

confidence: 97%

“…Further risk factors for the development of AK, besides advanced age, include male gender and fair skin type. Despite recent advancements in the prognostic classification of AK, pertinent guidelines recommend early and consequent treatment of AK, because it is currently not possible clinically or histologically to exactly delineate whether and which lesions will transform into cSCC [ 3 , 4 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of Interventions for Actinic Keratosis from Post-Marketing Surveillance Trials

Harlaß

et al. 2020

JCM

Self Cite

Multiple interventions are available for the treatment of actinic keratosis (AK) showing high efficacy in pivotal trials. However, data from post-marketing surveillance studies have received little attention until now. Here, we systematically investigate interventions for AK from post-marketing surveillance trials as a proxy for real-world efficacy and tolerability. A systematic literature search was conducted in Medline, Embase, and CENTRAL. Pertinent trial registers were hand-searched until 25 March 2020. Results were pooled using a random-effects model to calculate pooled proportions and relative risks (RR) or were described qualitatively. Eleven records with a total sample size of n = 4109 were included. Three of the studies had an active-controlled design, while seven were single-armed. Participant complete clearance ranged from 23.1% for diclofenac sodium 3% gel to 88.9% for ingenol mebutate 0.05% gel. The lesion-specific clearance rate for photodynamic therapy (PDT) was 74% (95% confidence interval (CI) 56–87%). The recurrence rate was significantly higher for diclofenac sodium 3% in comparison to imiquimod 5% cream (RR 1.10, 95% CI 1.02–1.1.8) and ranged from 10.6% for ingenol mebutate 0.015% gel to 23.5% for PDT. Few patients discontinued the trials due to adverse events. The results from the majority of the post-marketing surveillance studies deviated from those of pivotal trials.

“…However, if multiple lesions or clinical signs of field cancerization are present, the progression rates increase markedly, and spontaneous regression is less likely to occur. International guidelines recommend early and consequent treatment of AK as it is clinically and histologically difficult to predict if and which lesions will progress into cSCC 4,5 . The concept of field cancerization has initiated a paradigm shift in AK therapy from lesion‐directed to field‐directed therapies.…”

Section: Introductionmentioning

confidence: 99%

Chemical peelings for the treatment of actinic keratosis: a systematic review and meta‐analysis

Koch

et al. 2020

Acad Dermatol Venereol

Background Actinic keratosis (AK) is a common precancerous lesion of the skin that may be treated with chemical peelings. Despite their long‐standing usage and clinical experience, no evidence‐based recommendation regarding the efficacy and safety of chemical peelings for AK exists. Objectives To systematically review and synthesize the current knowledge on chemically exfoliative peelings as interventions for AK. Methods We performed a systematic literature research in Medline, Embase and CENTRAL and hand‐searched pertinent trial registers for eligible records until 5 August 2019. Results from individual studies were pooled using a random‐effects model or described in a qualitative synthesis. The risk of bias was estimated with the tools provided by the Cochrane Collaboration (randomized and non‐randomized trials) and the Evidence Project (single‐arm trials). Results Four randomized controlled trials, two non‐randomized controlled trials and two single‐arm studies with a total sample size of n = 170 patients were included. Trichloroacetic acid (TCA) plus Jessner’s solution showed significantly lower participant complete clearance (RR 0.36, 95% CI: 0.14–0.90, two studies, I2 = 0%, P = 0.03) and lower lesion clearance (RR 0.92, 95% CI: 0.85–0.99, one study, P = 0.03) compared to 5‐fluorouracil (5‐FU) 5% cream. TCA as monotherapy showed lower lesion complete clearance (RR 0.75, 95% CI: 0.69–0.82, two studies, I2 = 7%, P < 0.001) and lower mean lesion reduction per patient compared to conventional photodynamic therapy (cPDT) (MD −20.48, 95% CI: −31.55 to −9.41, two studies, I2 = 43%, P = 0.0003). Pain was more pronounced in patients treated with cPDT in comparison with TCA (MD −1.71 95% CI: −3.02 to −0.41, two studies, I2 = 55%, P = 0.01). In the single‐arm studies, 5‐FU plus glycolic acid showed 92% lesion clearance and phenol peeling 90.6% participant complete clearance. All studies showed a high risk for bias. Conclusions Future high‐quality studies and a standardization of peeling protocols are warranted to determine the value of chemical peelings in the treatment of AK.