Structured Expert Consensus on Actinic Keratosis: Treatment Algorithm Focusing on Daylight PDT

Calzavara‐Pinton, Piergiacomo; Hædersdal, Merete; Barber, Kirk; Basset-Séguin, Nicole; Flores, María Emilia del Pino; Foley, Peter; Galimberti, Gastón; Gerritsen, Rianne M. J. P.; Gilaberte, Yolanda; Ibbotson, Sally H.; Peris, Ketty; Sapra, Sheetal; Sotiriou, Eleni; Torezan, Luís; Ulrich, Claas; Guillemot, J.; Hendrich, J.; Szeimies, Rolf‐Markus

doi:10.1177/1203475417702994

Cited by 34 publications

(41 citation statements)

References 21 publications

(70 reference statements)

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“…However, high quality of cosmesis consistently observed in PDT studies for NMSC indications including AK, combined with increasing emphasis on patient choice over therapy, may see increased demand for topical PDT. A recent systematic review of AK clinical guidelines to construct a treatment algorithm positioned DL‐PDT a valuable option for patients with multiple AKs in small or large fields …”

Section: Current Indicationsmentioning

confidence: 99%

“…A recent systematic review of AK clinical guidelines to construct a treatment algorithm positioned DL-PDT a valuable option for patients with multiple AKs in small or large fields. 99 Squamous cell carcinoma in situ (Bowen's disease)/invasive SCC Squamous cell carcinoma in situ (strength of recommendation A, quality of evidence 1) (approved indication)…”

Section: Current Indicationsmentioning

confidence: 99%

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European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 1: treatment delivery and established indications – actinic keratoses, Bowen's disease and basal cell carcinomas

Morton¹,

Szeimies

Basset-Séguin

et al. 2019

Acad Dermatol Venereol

128

108

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Topical photodynamic therapy (PDT) is a widely approved therapy for actinic keratoses, Bowen's disease (squamous cell carcinoma in situ), superficial and certain thin basal cell carcinomas. Recurrence rates when standard treatment protocols are used are typically equivalent to existing therapies, although inferior to surgery for nodular basal cell carcinoma. PDT can be used both as lesional and field therapies and has the potential to delay/reduce the development of new lesions. A protocol using daylight to treat actinic keratoses is widely practised, with conventional PDT using a red light after typically a 3‐h period of occlusion employed for other superficial skin cancer indications as well as for actinic keratoses when daylight therapy is not feasible. PDT is a well‐tolerated therapy although discomfort associated with conventional protocol may require pain‐reduction measures. PDT using daylight is associated with no or minimal pain and preferred by patient. There is an emerging literature on enhancing conventional PDT protocols or combined PDT with another treatment to increase response rates. This guideline, published over two parts, considers all current approved and emerging indications for the use of topical PDT in dermatology, prepared by the PDT subgroup of the European Dermatology Forum guidelines committee. It presents consensual expert recommendations reflecting current published evidence.

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Section: Current Indicationsmentioning

confidence: 99%

Section: Current Indicationsmentioning

confidence: 99%

European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 1: treatment delivery and established indications – actinic keratoses, Bowen's disease and basal cell carcinomas

Morton¹,

Szeimies

Basset-Séguin

et al. 2019

Acad Dermatol Venereol

128

108

View full text Add to dashboard Cite

show abstract

“…In the most recent expert consensus, dPDT has been positioned as a valuable option for patients with multiple AKs in small or large fields [25]. …”

Section: Clinical Applicationsmentioning

confidence: 99%

Photodynamic therapy in dermatology beyond non-melanoma cancer: An update

Wen

Hamblin

2017

Photodiagnosis and Photodynamic Therapy

144

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Photodynamic therapy (PDT) employs a photosensitizer (PS) and visible light in the presence of oxygen, leading to production of cytotoxic reactive oxygen species, which can damage the cellular organelles and cause cell death. In dermatology PDT has usually taken the form of topical application of a precursor in the heme biosynthesis pathway, called 5-aminolevulinic acid (or its methyl ester), so that an active PS, protoporphyrin IX accumulates in the skin. As PDT enhances dermal remodeling and resolves chronic inflamation, it has been used to treat cutaneous disorders include actinic keratoses, acne, viral warts, skin rejuvenation, psoriasis, localized scleroderma, some non-melanoma skin cancers and port-wine stains. Efforts are still needed to mitigate the side effects (principally pain) and improve the overall procedure.

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“…In a randomized, controlled trial in Europe, MAL DL‐PDT demonstrated similar efficacy, better tolerability with less pain and resulted in higher subject satisfaction compared to MAL c‐PDT . Furthermore, a structured expert consensus statement on AK recently rated MAL DL‐PDT as the preferred option for patients with multiple AKs on both small and large fields due to its efficacy and tolerability profile …”

Section: Introductionmentioning

confidence: 99%

Patient and physician satisfaction in an observational study with methyl aminolevulinate daylight photodynamic therapy in the treatment of multiple actinic keratoses of the face and scalp in six European countries

Fargnoli

Ibbotson

Hunger

et al. 2017

Acad Dermatol Venereol

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BackgroundGuidelines recommend treating actinic keratoses (AKs) as they are recognized as precursors of invasive squamous cell carcinoma.ObjectiveThe objective of this study was to collect real‐world clinical data on the use of methyl aminolevulinate daylight photodynamic therapy (MAL DL‐PDT) for the treatment of face and scalp AK in Europe.MethodsA prospective, multicenter, non‐interventional study was conducted in six European countries in patients receiving a single treatment of MAL DL‐PDT for face and/or scalp AK. Patient‐reported outcomes were assessed by patient questionnaires at baseline and at 3 months after treatment, efficacy was assessed at 3 months using a 6‐point global improvement scale, and adverse events (AE) were recorded at each visit.ResultsOverall, 325 patients were enrolled from 52 investigational centres, 314 of whom attended the 3‐month visit. Most patients had multiple lesions (58.4% had >10 lesions) with lesions mainly located on the scalp (60.0%) and/or forehead (54.2%). AKs were predominantly grade I (39.4%) or grade II (33.2%), and 10.5% of patients had grade III lesions. The proportions of patients and physicians that were overall satisfied to very satisfied with the MAL DL‐PDT treatment were 80.4% and 90.3%, respectively. The vast majority of patients (90.0%) would consider using MAL DL‐PDT again if needed. Physician‐assessed efficacy at 3 months was at least much improved in 83.5% of patients, with 45.9% of patients requiring no retreatment. Related AEs were reported in 15% of patients.ConclusionUse of MAL DL‐PDT for multiple face and/or scalp AKs resulted in high levels of patient and physician satisfaction in clinical practice in Europe, reflecting the good efficacy and high tolerability of this convenient procedure.

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Structured Expert Consensus on Actinic Keratosis: Treatment Algorithm Focusing on Daylight PDT

Cited by 34 publications

References 21 publications

European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 1: treatment delivery and established indications – actinic keratoses, Bowen's disease and basal cell carcinomas

European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 1: treatment delivery and established indications – actinic keratoses, Bowen's disease and basal cell carcinomas

Photodynamic therapy in dermatology beyond non-melanoma cancer: An update

Patient and physician satisfaction in an observational study with methyl aminolevulinate daylight photodynamic therapy in the treatment of multiple actinic keratoses of the face and scalp in six European countries

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