Management of actinic keratosis at specific body sites in patients at high risk of carcinoma lesions: expert consensus from the AKTeam™ of expert clinicians

Abstract

Actinic keratoses (AK) arise on sun-exposed regions of the skin. If left untreated, AK may progress to invasive squamous cell carcinoma (SCC), although the rate of progression is low. A practical treatment algorithm for the treatment of AK in standard situations has been published by the AKTeam expert panel. However, management of particular situations of AK with increasing/higher carcinoma risk or AK progressing into carcinomas with increased aggressiveness due to their anatomical location (risky areas), or in patients with an increased risk of SCC requires further discussion. These include AK on the dorsal hands, forearms, legs, periorbital region, eyelids, ears, or lips, and organ transplant recipients, patients undergoing treatment with carcinogenic agents and patients with chronic lymphocytic leukaemia. The main objective was to propose therapeutic strategies for the treatment of AK located in risky areas and in patients with more invasive/aggressive lesions and a higher risk of progression to SCC. A systematic review of the literature was initially performed, and results were discussed by the experts to propose best management practices in specific situations. Finally, adapted management strategies for AK occurring in risky areas and in high-risk patients are presented, taking into account the experts' own clinical experience and current guidelines. In most of these 'at-risk' situations, patients can be treated according to the AKTeam treatment algorithm. Difficult-to-treat lesions should be treated more aggressively due to their higher risk of transformation. For patients with skin that is highly susceptible to actinic damage, monitoring and sun protection strategies are mandatory, and patients should undergo more regular follow-up. Further assessment of newer therapies in clinical trials is necessary to determine optimal treatment conditions. This expert consensus provides guidance for the management of AK in risky body sites and in patients with an increasing/higher risk for SCCs.

Italian expert consensus paper on the management of patients with actinic keratoses

“…Several guidelines and consensus papers on how to manage patients with AKs have been published recently. [1][2][3][4][5][6][7][8][9][10] However, given the continuing introduction of new treatments and the rising amount of literature on the topic, updated recommendations are warranted.…”

Predicting keratinocyte carcinoma in patients with actinic keratosis: development and internal validation of a multivariable risk‐prediction model

“…high UVR exposure) have been described to increase progression risk. [8][9][10] Correctly identifying high-risk patients is important to detect KCs at an early stage and to ensure timely intervention. Moreover, stratified AK management may reduce patients' anxiety, provide better management for high-risk individuals, and optimize the use of healthcare resources.…”

Efficacy of topical imiquimod 3.75% in the treatment of actinic keratosis of the scalp in immunosuppressed patients: our case series

“…In this latter category, OTRs, as well as subjects suffering from hematological neoplasms (i.e. chronic lymphocytic leukemia) are included, and the authors recommend an early treatment of the lesions, through the use of Photodynamic Therapy (PDT), laser ablation and/or curettage and surgery, together with a regular and strict follow-up (16).…”