Real-world approach to actinic keratosis management: practical treatment algorithm for office-based dermatology

Abstract

Actinic keratosis (AK) is a chronic skin disease in which multiple clinical and subclinical lesions co-exist across large areas of sun-exposed skin, resulting in field cancerisation. Lesions require treatment because of their potential to transform into invasive squamous cell carcinoma. This article aims to provide office-based dermatologists and general practitioners with simple guidance on AK treatment in daily clinical practice to supplement existing evidence-based guidelines. Novel aspects of the proposed treatment algorithm include differentiating patients according to whether they have isolated scattered lesions, lesions clustered in small areas or large affected fields without reference to specific absolute numbers of lesions. Recognising that complete lesion clearance is rarely achieved in real-life practice and that AK is a chronic disease, the suggested treatment goals are to reduce the number of lesions, to achieve long-term disease control and to prevent disease progression to invasive squamous cell carcinoma. In the clinical setting, physicians should select AK treatments based on local availability, and the presentation and needs of their patients. The proposed AK treatment algorithm is easy-to-use and has high practical relevance for real-life, office-based dermatology. areas or large affected fields without reference to specific absolute numbers of lesions. Recognising that complete lesion clearance is rarely achieved in real-life practice and that AK is a chronic disease, the suggested treatment goals are to reduce the number of lesions, to achieve long-term disease control and to prevent disease progression to invasive squamous cell carcinoma. In the clinical setting, physicians should select AK treatments based on local availability, and the presentation and needs of their patients. The proposed AK treatment algorithm is easy-to-use and has high practical relevance for real-life, office-based dermatology.

Physician–patient communication and patient‐reported outcomes in the actinic keratosis treatment adherence initiative (AK‐TRAIN): a multicenter, prospective, real‐life study of treatment satisfaction, quality of life and adherence to topical field‐directed therapy for the treatment of actinic keratosis in Italy

“…Patients with multiple AKs should be treated with field‐directed therapy. However, such treatments challenge patients’ adherence and potentially hamper real‐life effectiveness due to side effects, out‐of‐pocket costs, length of treatment and severity of local skin reactions (LSRs) …”

Late fusion of deep and shallow features to improve discrimination of actinic keratosis from normal skin using clinical photography

“…Clinical photography is accepted as a standard documentation tool for cutaneous diseases and is recommended, particularly in patients with multiple AK lesions, at initial and follow‐up visits to monitor treatment response . The automatic recognition of AK from clinical photographs remains a quite challenging task and deep CNN holds promise for substantial improvements in classification accuracy.…”

Evaluation of two histological classifications for actinic keratoses – PRO classification scored highest inter‐rater reliability

“…The incidence in fair skin people continues to increase due to a change in demography and leisure activities in industrial nations. AKs represent chronic disease which should be treated to control field change and to possibly prevent progression into invasive SCC . However, with increasing numbers of patients with AKs, social and economic issues require consideration as there would be a substantial impact on health budgets.…”