Also known as solar keratosis, actinic keratosis (AK) is one of the most common neoplastic skin lesions with the potential to progress into invasive squamous cell carcinoma (SCC). AK lesions typically occur in individuals with chronic photodamage, and are particularly frequent and especially challenging to treat in immunosuppressed individuals, such as organ transplant recipients.
Several different therapies are currently being used for the treatment of AKs, including cryotherapy, electrodessication and curettage, topical 5-fluorouracil (5-FU), imiquimod, ingenol mebutate, and topical diclofenac, as well as photodynamic therapy (PDT) performed with 5-aminolevulinic acid (ALA) solution or methyl aminolevulinate (MAL).
Although all of these treatment options have varying degrees of proven efficacy for the clearance of AKs, none of the newer therapies have been tested in head-to-head clinical trials to reveal clinical superiority among them. As such, it is not uncommon that clinicians find themselves at odds as to which therapy to choose from and which modality could achieve the best clearance results in their patients.
International guidelines introduced
This growing sense of urgency has led to the establishment of the first internationally accepted treatment guidelines for actinic keratosis, a work recently put forth by the collaboration between the European Dermatology Forum and the International League of Dermatological Societies (ILDS).
“There has been a growing need for international guidelines regarding the treatment of actinic keratosis, witnessed in the different conceptions of actinic keratosis and treatment implications in the international community. With the introduction of the global AK treatment guidelines, our hope is to bridge the divide and further advance and standardize the perception of AKs and how to best treat and manage these lesions in different clinical scenarios. This includes optimal treatment strategies and recommendations for solitary AK lesions and groups of lesions, as well as field cancerization cases,” says Professor Eggert Stockfleth, M.D., Klinik for Dermatology, Venereology, and Allergy, St. Joseph Hospital, Ruhr University Bochum, Bochum, Germany.
Dr. Stockfleth spearheaded the guidelines subcommittee, an international expert panel consisting of fifteen dermatologists nominated by the ILDS, three dermatopathologists and one patient representative. The expert team performed a systematic assessment of the efficacy and safety of the available treatment options and put together robust evidence-based (S3) guidelines for the treatment and management of AKs.1
Podcast: Pros and cons of eradicating AKs