Piergiacomo Calzavara-Pinton1, Merete Hædersdal2, Kirk Barber3, Nicole Basset-Seguin4, María Emilia Del Pino Flores5, Peter Foley6, Gaston Galimberti7, Rianne Gerritsen8, Yolanda Gilaberte9, Sally Ibbotson10, Ketty Peris11, Sheetal Sapra12, Elena Sotiriou13, Luis Torezan14, Claas Ulrich15, Jonathan Guillemot16,17, Janek Hendrich16, Rolf-Markus Szeimies18. 1. Department of Dermatology, University of Brescia, Brescia, Italy. 2. Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. 3. Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. 4. Department of Dermatology, Hospital Saint-Louis, Université Paris 7, Paris, France. 5. Hospital Ángeles del Pedregal, Mexico City, Mexico. 6. Department of Medicine (Dermatology), University of Melbourne; St Vincent's Hospital Melbourne, Fitzroy, and Skin & Cancer Foundation, Carlton, Australia. 7. Department of Dermatology, School of Medicine, Hospital Italiano, Buenos Aires, Argentina. 8. Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands. 9. Department of Dermatology, Hospital San Jorge, Huesca, Spain. 10. Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK. 11. Catholic University of Rome, Fondazione Policlinico Gemelli, Rome, Italy. 12. Institute of Cosmetic and Laser Surgery, Oakville, Ontario, Canada. 13. First Dermatology Department, Aristotle University, Thessaloniki, Greece. 14. Hospital das Clinicas Faculdade de Medicina Universidade de São Paulo, São Paulo, Brazil. 15. Skin Tumor Center of Charité, Berlin, Germany. 16. Amaris, London, UK. 17. Universidad San Francisco de Quito USFQ, Escuela de Medicina, Quito, Ecuador. 18. Department of Dermatology and Allergology, Vest Hospital, Academic Teaching Hospital University of Bochum, Recklinghausen, Germany.
Abstract
BACKGROUND: A practical and up-to-date consensus among experts is paramount to further improve patient care in actinic keratosis (AK). OBJECTIVES: To develop a structured consensus statement on the diagnosis, classification, and practical management of AK based on up-to-date information. METHODS: A systematic review of AK clinical guidelines was conducted. This informed the preparation of a 3-round Delphi procedure followed by a consensus meeting, which combined the opinions of 16 clinical experts from 13 countries, to construct a structured consensus statement and a treatment algorithm positioning daylight photodynamic therapy (dl-PDT) among other AK treatment options. RESULTS: The systematic review found deficiencies in current guidelines with respect to new AK treatments such as ingenol mebutate and dl-PDT. The Delphi panel established consensus statements across definition, diagnosis, classification, and management of AK. While the diagnosis of AK essentially rests on the nature of lesions, treatment decisions are based on several clinical and nonclinical patient factors and diverse environmental attributes. Participants agreed on ranked treatment preferences for the management of AK and on classifying AK in 3 clinical situations: isolated AK lesions requiring lesion-directed treatment, multiple lesions within a small field, and multiple lesions within a large field, both requiring specific treatment approaches. Different AK treatment options were discussed for each clinical situation. CONCLUSIONS: The results provide practical recommendations for the treatment of AK, which are readily transferable to clinical practice, and incorporate the physician's clinical judgement. The structured consensus statement positioned dl-PDT as a valuable option for patients with multiple AKs in small or large fields.
BACKGROUND: A practical and up-to-date consensus among experts is paramount to further improve patient care in actinic keratosis (AK). OBJECTIVES: To develop a structured consensus statement on the diagnosis, classification, and practical management of AK based on up-to-date information. METHODS: A systematic review of AK clinical guidelines was conducted. This informed the preparation of a 3-round Delphi procedure followed by a consensus meeting, which combined the opinions of 16 clinical experts from 13 countries, to construct a structured consensus statement and a treatment algorithm positioning daylight photodynamic therapy (dl-PDT) among other AK treatment options. RESULTS: The systematic review found deficiencies in current guidelines with respect to new AK treatments such as ingenol mebutate and dl-PDT. The Delphi panel established consensus statements across definition, diagnosis, classification, and management of AK. While the diagnosis of AK essentially rests on the nature of lesions, treatment decisions are based on several clinical and nonclinical patient factors and diverse environmental attributes. Participants agreed on ranked treatment preferences for the management of AK and on classifying AK in 3 clinical situations: isolated AK lesions requiring lesion-directed treatment, multiple lesions within a small field, and multiple lesions within a large field, both requiring specific treatment approaches. Different AK treatment options were discussed for each clinical situation. CONCLUSIONS: The results provide practical recommendations for the treatment of AK, which are readily transferable to clinical practice, and incorporate the physician's clinical judgement. The structured consensus statement positioned dl-PDT as a valuable option for patients with multiple AKs in small or large fields.
Authors: M C Fargnoli; S H Ibbotson; R E Hunger; G Rostain; M T W Gaastra; L Eibenschutz; C Cantisani; A W Venema; S Medina; N Kerrouche; B Pérez-Garcia Journal: J Eur Acad Dermatol Venereol Date: 2017-12-26 Impact factor: 6.166