Actinic keratosis vagaries: Consensus committee addresses problem of 'overlapping identities'

May 1, 2009

Research suggests that AKs are most likely early-stage superficial SCCs. The dermatology, pathology and dermatopathology communities need to change their classification or prove that AKs are distinct, an expert says. Virtually all AK research is fraught with inadequate data and lack of standardized protocols, he says.

Key Points

To begin addressing the problem of overlapping identities, George Martin, M.D., a private practitioner in Kihei, Hawaii, convened a day-long consensus conference on the heels of the Advances in Cosmetic and Medical Dermatology Conference in January. Millennium Medical Communications of Hampton, N.H., organized the event.

The most important outcome, he says, was settling on a new, temporary name - solar keratotic intraepidermal neoplasm. In the long run, participants in the consensus conference say they expect AK to merge with superficial SCC - and lose its differentiated identity, Dr. Martin says.

The purpose of an intermediate designation, he says, is to signal changes ahead and encourage dermatopathologists and pathologists to update their research and bring more consistency and congruency to the lesion classification system.

Treatment protocols

Although time-pressed, dermatologists need to continue moving from a generalized to an individualized treatment approach, Dr. Martin says.

In determining the best treatment for any given patient, physicians should factor in the following variables: Severity of disease; comorbidity of diseases; age and health status; whether a patient is immunocompromised, residing in a nursing home, or living alone; the kind and extent of insurance coverage; and the ease or difficulty of a patient's access to care.

"We concluded that liquid nitrogen, the most common treatment for AK, is inadequate," Dr. Martin tells Dermatology Times. However, the group could not yet recommend a matrix of preferred modalities.

The reason is twofold. First, the sheer number of treatment options makes for unwieldy comparisons. Second, and more important, research methodologies are inadequate.

It's impossible to definitively ascertain the efficacy of a drug or the superiority of one drug over another without standardized protocols and better methods for measuring outcomes. Additionally, research models need to address the issue of inter-and intra-observer variability in counting AKs, Dr. Martin says.

"AKs," he says, "are a chronic, lifelong, and in most cases, progressive disease that, over time, will often result in invasive SCC and may, in rare cases, result in death."

Disclosure: The Millennium Communications Group plans to use the work of the consensus conference to develop CME modules and webinars. Dr. Martin has been an adviser and consultant to DUSA, Galderma, Sanofi-Aventis and Valeant.

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