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Management of actinic keratosis: a practical report and treatment algorithm from AKT eam TM expert clinicians

2014; Wiley; Volume: 28; Issue: 9 Linguagem: Inglês

10.1111/jdv.12434

1468-3083

Brigitte Dréno, J.-M. Amici, Nicole Basset‐Séguin, B. Cribier, Jean‐Paul Claudel, M.‐A. Richard,

Cutaneous Melanoma Detection and Management

Abstract Background Actinic keratoses ( AK ) are common photo‐induced cutaneous lesions that may progress to invasive squamous‐cell carcinoma and serve as a risk marker for skin cancer. Although numerous studies present the various therapeutic options for AK , publications that can be used to pragmatically guide dermatologists in their daily practice are limited. National and international guidelines have been published, however, they are based on clinical trials with highly selected patient populations and do not always capture the range of patients seen in everyday practice. Objective The objective of this expert panel of F rench dermatologists was to present an analysis of AK geared towards everyday practice, to express an informed opinion about most recent treatments, and to propose a treatment algorithm for AK for daily practice in F rance. Methods Over a 12 month period, six expert dermatologists in the field of AK ( AKT eam TM expert panel) met regularly to formulate an opinion about treatment in everyday practice compared with the analysis of the literature and guidelines published since 1990. Results Definitions, terminology, diagnosis and risk factors were summarized. Data from the literature and current practices related to the initial evaluation, indications for biopsy, therapeutic indications, therapeutic options and effectiveness, monitoring and prevention were discussed. A pragmatic treatment algorithm was formalized according to current data available. This practical algorithm distinguishes between different clinical situations depending on the number of AK , their hyperkeratotic or suspicious nature, and includes cryotherapy, curettage‐electrocoagulation, 5% 5‐fluorouracil, 3% diclofenac sodium, 5% imiquimod, 150 and 500 μg/g ingenol mebutate, lasers, photodynamic therapy and surgery. Conclusion This up‐to‐date expert opinions about AK and its treatment provide a management strategy and practical treatment algorithm for AK for F rench dermatologists to use.