R N Werner1, E Stockfleth2, S M Connolly3, O Correia4, R Erdmann1, P Foley5,6,7, A K Gupta8,9, A Jacobs1, H Kerl10, H W Lim11, G Martin12, M Paquet9, D M Pariser13, S Rosumeck1, H-J Röwert-Huber14, A Sahota15, O P Sangueza16,17, S Shumack18, B Sporbeck1, N A Swanson19,20, L Torezan21, A Nast1. 1. Division of Evidence Based Medicine (dEBM), Department of Dematology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany. 2. Department of Dermatology, Venerology and Allergology, Skin Cancer Center (HTCC), Charité - Universitätsmedizin Berlin, Berlin, Germany. 3. Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA. 4. Centro Dermatologia Epidermis, Instituto CUF and Faculty of Medicine of University of Porto, Porto, Portugal. 5. Skin and Cancer Foundation Victoria, Carlton, Victoria, Australia. 6. St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia. 7. The University of Melbourne, Melbourne, Victoria, Australia. 8. Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 9. Mediprobe Research Inc., London, Ontario, Canada. 10. Department of Dermatology, Medical University of Graz, Graz, Austria. 11. Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA. 12. Dermatology Laser Center of Maui, Kihei, Hawaii, USA. 13. Division of Dermatology and Virginia Clinical Research Inc, Eastern Virginia Medical School, Norfolk, Virginia, USA. 14. Division of Dermatopathology, Department of Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany. 15. Department of Dermatology, Whipps Cross University Hospital, London, UK. 16. Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA. 17. Department of Dermatology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA. 18. Department of Dermatology, Northern Medical School, University of Sydney, Sydney, New South Wales, Australia. 19. Dermatology, Surgery, and Otolaryngology, Oregon Health and Science University, Portland, Oregon, USA. 20. Surgical and Cosmetic Dermatology and Clinical Operations, Oregon Health and Science University Knight Cancer Institute, Portland, Oregon, USA. 21. Faculty of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil.
Abstract
BACKGROUND: Actinic keratosis (AK) is a frequent health condition attributable to chronic exposure to ultraviolet radiation. Several treatment options are available and evidence based guidelines are missing. OBJECTIVES: The goal of these evidence- and consensus-based guidelines was the development of treatment recommendations appropriate for different subgroups of patients presenting with AK. A secondary aim of these guidelines was the implementation of knowledge relating to the clinical background of AK, including consensus-based recommendations for the histopathological definition, diagnosis and the assessment of patients. METHODS: The guidelines development followed a pre-defined and structured process. For the underlying systematic literature review of interventions for AK, the methodology suggested by the Cochrane Handbook for Systematic Reviews of Interventions, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was adapted. All recommendations were consented during a consensus conference using a formal consensus methodology. Strength of recommendations was expressed based on the GRADE approach. If expert opinion without external evidence was incorporated into the reasoning for making a certain recommendation, the rationale was provided. The Guidelines underwent open public review and approval by the commissioning societies. RESULTS: Various interventions for the treatment of AK have been assessed for their efficacy. The consenting procedure led to a treatment algorithm as shown in the guidelines document. Based on expert consensus, the present guidelines present recommendations on the classification of patients, diagnosis and histopathological definition of AK. Details on the methods and results of the systematic literature review and guideline development process have been published separately. CONCLUSIONS: International guidelines are intended to be adapted to national or regional circumstances (regulatory approval, availability and reimbursement of treatments).
BACKGROUND:Actinic keratosis (AK) is a frequent health condition attributable to chronic exposure to ultraviolet radiation. Several treatment options are available and evidence based guidelines are missing. OBJECTIVES: The goal of these evidence- and consensus-based guidelines was the development of treatment recommendations appropriate for different subgroups of patients presenting with AK. A secondary aim of these guidelines was the implementation of knowledge relating to the clinical background of AK, including consensus-based recommendations for the histopathological definition, diagnosis and the assessment of patients. METHODS: The guidelines development followed a pre-defined and structured process. For the underlying systematic literature review of interventions for AK, the methodology suggested by the Cochrane Handbook for Systematic Reviews of Interventions, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was adapted. All recommendations were consented during a consensus conference using a formal consensus methodology. Strength of recommendations was expressed based on the GRADE approach. If expert opinion without external evidence was incorporated into the reasoning for making a certain recommendation, the rationale was provided. The Guidelines underwent open public review and approval by the commissioning societies. RESULTS: Various interventions for the treatment of AK have been assessed for their efficacy. The consenting procedure led to a treatment algorithm as shown in the guidelines document. Based on expert consensus, the present guidelines present recommendations on the classification of patients, diagnosis and histopathological definition of AK. Details on the methods and results of the systematic literature review and guideline development process have been published separately. CONCLUSIONS: International guidelines are intended to be adapted to national or regional circumstances (regulatory approval, availability and reimbursement of treatments).
Keywords:
actinic keratosis; evidence based medicine; guideline; international guideline; practice guideline; recommendations; solar keratosis; squamous cell carcinoma; treatment
Authors: George Martin; Bruce E Strober; Craig L Leonardi; Joel M Gelfand; Andrew Blauvelt; Arthur Kavanaugh; Linda Stein Gold; Brian Berman; Ted Rosen; Eggert Stockfleth Journal: J Clin Aesthet Dermatol Date: 2016-09-01
Authors: Nathalie C Zeitouni; Neal Bhatia; Roger I Ceilley; Joel L Cohen; James Q Del Rosso; Angela Y Moore; Gilly Munavalli; David M Pariser; Todd Schlesinger; Daniel M Siegel; Andrea Willey; Mitchel P Goldman Journal: J Clin Aesthet Dermatol Date: 2021-10