Actinic keratosis is an early in situ squamous cell carcinoma: a proposal for reclassification

Röwert‐Huber, Joachim; Patel, Manisha J.; Forschner, T.; Ulrich, Claas; Eberle, Jürgen; Kerl, Helmut; Sterry, Wolfram; Stockfleth, Eggert

doi:10.1111/j.1365-2133.2007.07860.x

Cited by 312 publications

(363 citation statements)

References 21 publications

(29 reference statements)

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“…And several smaller retrospective studies gave an indication that change of the immunosuppressive regimen to sirolimus may have a positive effect on the development of NMSCs (13,14,18). (19,26,27,28 (31). On the other hand it is also clear that cyclosporine-treated patients have the same risk of developing NMSC (5,32,33), leading to the conclusion that duration and intensity of the immunosuppression and not specific immunosuppressive agents are the main risk factors for the development of NMSC (6,34,35,36 …”

Section: Nonmelanoma Skin Cancer Is One Of the Most Common Long-term mentioning

confidence: 99%

Switch to a Sirolimus‐Based Immunosuppression in Long‐Term Renal Transplant Recipients: Reduced Rate of (Pre‐)Malignancies and Nonmelanoma Skin Cancer in a Prospective, Randomized, Assessor‐Blinded, Controlled Clinical Trial

Salgo¹,

Goßmann

Schöfer³

et al. 2010

American Journal of Transplantation

199

137

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Renal transplant recipients (RTR) have a 50-200-fold higher risk for nonmelanoma-skin cancer (NMSC) causing high rates of morbidity and sometimes mortality. Cohort-studies gave evidence that a sirolimusbased immunosuppression may inhibit skin tumor growth. This single-center, prospective, assessorblinded, randomized trial investigated if switching to sirolimus treatment inhibits the progression of premalignancies and moreover how many new NMSC occur compared to continuation of the original immunosuppressive therapy. Forty-four RTR (mean age 59.9 years, mean duration of immunosuppression 229.5 months) with skin lesions were randomized to sirolimus or continuation of their original immunosuppression. Blinded dermatological assessment at month 6 and 12 by the same dermatologist evaluated the clinical change compared to baseline. Biopsy was performed in suspected malignancy. Already the 6-month-assessment showed significant superiority of sirolimus-therapy: a stop of progression, even regression of preexisting premalignancies (p < 0.0005). This effect was increased at month 12 (p < 0.0001). Nine patients developed histologically confirmed NMSC: one in the sirolimus group, eight in the control group, p = 0.0176. Sirolimus-based immunosuppression in RTR, even when established many years after transplantation, can delay the development of premalignancies, induce regression of preexisting lesions and decelerate the incidence of new NMSC.

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Section: Nonmelanoma Skin Cancer Is One Of the Most Common Long-term mentioning

confidence: 99%

Switch to a Sirolimus‐Based Immunosuppression in Long‐Term Renal Transplant Recipients: Reduced Rate of (Pre‐)Malignancies and Nonmelanoma Skin Cancer in a Prospective, Randomized, Assessor‐Blinded, Controlled Clinical Trial

Salgo¹,

Goßmann

Schöfer³

et al. 2010

American Journal of Transplantation

199

137

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“…These cutaneous legions have been noted to be more prevalent on sun exposed regions of the body compared to BCC and SCC leading to SK being noted as potentially better markers of sunlight exposure than the presence of skin cancers 8 . In addition to SK forming in frequently sun exposed regions of the body, SCC have been linked to the presence of pre-existing SK legions 10 leading to their being recognised as either pre-cursors to, or representative of the developmental stages of SCC 11 . In this research, the published facial distribution of SK 12 incidence and BCC 13 extends the work of previous research which has published NMSC site incidence data over broader regions of the body and face.…”

Section: Introductionmentioning

confidence: 99%

Measurements of the anatomical distribution of erythemal ultraviolet: a study comparing exposure distribution to the site incidence of solar keratoses, basal cell carcinoma and squamous cell carcinoma

Downs

Parisi

2009

Photochem Photobiol Sci

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“…Furthermore, AKs are histologically classified based on the Roewert-Huber histological classification system. This method analyzes the extent of atypical keratinocytes (AK I-III) [18]. The two systems have recently been shown not to correlate [19].…”

mentioning

confidence: 99%

A review of BF-200 ALA for the photodynamic treatment of mild-to-moderate actinic keratosis

Reinhold¹

2017

Future Oncol.

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BF-200 ALA is a combination of a nanoscale-lipid vesicle formulation and the prodrug 5-aminolevulinic acid (5-ALA). The nanoemulsion stabilizes the prodrug and enhances its penetration through the stratum corneum. It has shown excellent therapeutic results in both lesion and field-directed photodynamic therapy of actinic keratosis (AK). AK is an early form of epidermal neoplasia and a precursor of invasive cutaneous squamous cell carcinoma. It is characterized by the combination of visible neoplastic lesions and surrounding tissue also harboring tumorigenic UV-induced mutations: a concept called field cancerization. A selective, field-directed treatment is ideal to meet the requirements of field change. Here, we review the clinical data on BF-200 ALA for AK along with a summary of molecular mechanisms and future perspectives. Actinic keratosis (AK), also known as solar keratosis, is caused by chronic exposure to sunlight or other ultraviolet light sources [1,2] and may progress to invasive squamous cell carcinoma (SCC) [3]. It is the most common lesion with malignant potential to arise on the skin. AK is mostly seen in Caucasians in skin areas that have extensive sun exposure throughout their lives [4]. Epidemiological data show a high occurrence rate of AK. Regions with higher ultraviolet exposure have a higher prevalence of AK. For the USA, the prevalence was estimated to range from 11 to 26%, while in Australia it ranged from 40 to 60%. In Europe, a prevalence of 15% in men and 6% in women has been documented [5]. Over the age of 70 years, 34% of men and 18% of women were found to have actinic keratotic lesions [6]. Next to fair skin type, an advanced age and lifelong sun exposure immunosuppression/-deficiency plays another important risk factor [5].Mostly, AK develops slowly and early in the disease process, they may disappear only to reappear later. Recurrence of the disease may include partial elimination of the initial lesion, subclinical lesion progression to visible status, or development of new lesions [7]. On top of this, an AK may progress to invasive SCC, the second-most common form of skin cancer [8,9]. The actual percentage of progress to invasive SCC remains unknown, and estimates vary from 5 to 20% within 10 to 25 years with reported annual transformation rates varying greatly from as low as 0.25% to as high as 16% [10]. The regression rate for a single untreated lesion is 15 to 63% after a year; recurrence rates range from 15 to 53% [11]. In general patients develop multiple AKs in one area and predicting which course each individual lesion will follow is impossible. Nonetheless, AK lesions are reliable markers for patients who are most predisposed to developing invasive SCC [4,[12][13].AK lesions typically appear in areas most frequently exposed to the sun such as the face, back of the hands, or bald scalp; 75% of lesions are found on the head, neck and forearms [14]. The lesions vary in appearance as well as size and can include erythematous scaly macules, rough pigmented patches and hyperker...

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Actinic keratosis is an early in situ squamous cell carcinoma: a proposal for reclassification

Cited by 312 publications

References 21 publications

Switch to a Sirolimus‐Based Immunosuppression in Long‐Term Renal Transplant Recipients: Reduced Rate of (Pre‐)Malignancies and Nonmelanoma Skin Cancer in a Prospective, Randomized, Assessor‐Blinded, Controlled Clinical Trial

Switch to a Sirolimus‐Based Immunosuppression in Long‐Term Renal Transplant Recipients: Reduced Rate of (Pre‐)Malignancies and Nonmelanoma Skin Cancer in a Prospective, Randomized, Assessor‐Blinded, Controlled Clinical Trial

Measurements of the anatomical distribution of erythemal ultraviolet: a study comparing exposure distribution to the site incidence of solar keratoses, basal cell carcinoma and squamous cell carcinoma

A review of BF-200 ALA for the photodynamic treatment of mild-to-moderate actinic keratosis

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