title: 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.
authors: a Centroderm Clinic, Wuppertal, and Faculty of Health , University of Witten-Herdecke , Witten , Germany.
authors: Thomas
authors: T
authors: Dirschka
authors: b Department of Dermatology , Monklands Hospital, Lanarkshire, and University of Glasgow , Glasgow , UK.
authors: Girish
authors: G
authors: Gupta
authors: c Dermatology Clinic , University of Catania , Catania , Italy.
authors: Giuseppe
authors: G
authors: Micali
authors: d Klinik für Dermatologie, Venerologie und Allergologie , St. Josef-Hospital, Ruhr-Universität Bochum , Bochum , Germany.
authors: Eggert
authors: E
authors: Stockfleth
authors: e Policlinique de Dermatologie , Hôpital Saint-Louis , Paris , France.
authors: Nicole
authors: N
authors: Basset-Séguin
authors: f Department of Dermatology , Hôpital Erasme - Université Libre de Bruxelles , Bruxelles , Belgium.
authors: Véronique
authors: V
authors: Del Marmol
authors: g Department of Dermatology Skin Cancer Unit , University Hospital Zürich , Zurich , Switzerland.
authors: Reinhard
authors: R
authors: Dummer
authors: h Department of Dermatology , Zealand University Hospital, Roskilde; Health Sciences Faculty, University of Copenhagen , Copenhagen , Denmark.
authors: Gregor B E
authors: GBE
authors: Jemec
authors: i Dermatology Department , Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona , Barcelona , Spain.|j Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) , Valencia , Spain.
authors: Josep
authors: J
authors: Malvehy
authors: k Department of Dermatology , Catholic University of Rome , Largo A. Gemelli 8 , Rome , Italy.
authors: Ketty
authors: K
authors: Peris
authors: i Dermatology Department , Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona , Barcelona , Spain.|j Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) , Valencia , Spain.
authors: Susana
authors: S
authors: Puig
authors: l First Department of Dermatology-Venereology , University of Athens Medical School, Andreas Sygros Hospital , Athens , Greece.
authors: Alexander J
authors: AJ
authors: Stratigos
authors: m Non-Melanoma Skin Cancer Unit, Department of Dermatology and Venereology , Medical University of Graz , Graz , Austria.
authors: Iris
authors: I
authors: Zalaudek
authors: n Department of Dermatology , University of Modena and Reggio Emilia , Modena , Italy.
authors: Giovanni
authors: G
authors: Pellacani
mesh_terms: D000465:Algorithms; D000634:Aminoquinolines / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D017679:Cryotherapy; D018450:Disease Progression; D006801:Humans; D000077271:Imiquimod; D055623:Keratosis, Actinic / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D053685:Laser Therapy
chemical_list: D000634:Aminoquinolines; D000970:Antineoplastic Agents; D000077271:Imiquimod
keywords: 5-fluorouracil; Diclofenac; field cancerisation; imiquimod; ingenol mebutate; photodynamic therapy