therapy. Adequate patient counseling on and implementation of measures to reduce UV exposure could mitigate chronic actinic damage and risk of developing future skin cancers.16 However, when AKs do appear, not only should the individual tumor be treated, but the surrounding areas may also require treatment given concerns of field cancerization (ie, an area of clonallyexpanded pre-malignant lesions) which may be a harbinger of future skin cancers.14,17 Studies have demonstrated that multimodal, combination approaches to treatment (eg, combining either cryosurgery or lesion-directed photodynamic therapy with prescribed topical therapy) may yield greater efficacy.18
Patient adherence to therapy is also a significant factor affecting efficacy and can cause real-world outcomes to diverge from clinical trial results. Adherence is negatively affected by longer course therapy, complicated regimens, and adverse effects(including local skin reactions(LSR) in AK treatment).19,20 Dermatologists have employed multiple variations to approved treatment courses to mitigate brisk local skin reactions while optimizing clearance to maintain adherence.
The purpose of this consensus panel was to synthesize the available and most current literature into overarching principles to provide guidance on the management of AKs, improving patient experiences and treatment outcomes.
Patient adherence to therapy is also a significant factor affecting efficacy and can cause real-world outcomes to diverge from clinical trial results. Adherence is negatively affected by longer course therapy, complicated regimens, and adverse effects(including local skin reactions(LSR) in AK treatment).19,20 Dermatologists have employed multiple variations to approved treatment courses to mitigate brisk local skin reactions while optimizing clearance to maintain adherence.
The purpose of this consensus panel was to synthesize the available and most current literature into overarching principles to provide guidance on the management of AKs, improving patient experiences and treatment outcomes.
MATERIALS AND METHODS
A systematic review of the literature pertaining to the epidemiology, natural history, prognosis, management of actinic keratoses (AKs) as well as the mechanism of action (MoA) of and adherence to current therapy was conducted. The goal of this search was to evaluate the literature for evidence, review and development of recommendations by the expert panel. The Medline database was queried for all relevant articles published between 1980 and 2021 using exploded MeSH terms and keywords pertaining to the following themes: diagnosis, prognosis, and epidemiology, risk factors, squamous cell carcinoma, therapy. The Boolean term “AND†was used to find the intersection of these themes with the term “actinic keratosis.†Articles deemed relevant diagnosis and management of AK based on full-text review were selected for further discussion by members of the consensus panel.
A 10-person consensus panel of dermatologists and dermatopathologists selected for their expertise in histopathologic risk factors and management of AKs, prior extensive knowledge of atypical and malignant keratinocytic tumors, and/or history of academic achievement, were convened via a virtual platform during January 2021. Panel members discussed issues regarding the appropriate treatment of AKs given the current understanding of pathophysiology and real-world scenarios that may complicate treatment from a physician and patient perspective. Statements were drafted based on the selected articles and relevant discussion.
Consensus among panel members was achieved using a modified Delphi technique.21 Consensus was defined as agreement among at least a supermajority of 7/10 of the experts participating in the panel. If 7/10 agreement could not be achieved, the proposal was re-discussed among panel members and modified until agreement was achieved.
A 10-person consensus panel of dermatologists and dermatopathologists selected for their expertise in histopathologic risk factors and management of AKs, prior extensive knowledge of atypical and malignant keratinocytic tumors, and/or history of academic achievement, were convened via a virtual platform during January 2021. Panel members discussed issues regarding the appropriate treatment of AKs given the current understanding of pathophysiology and real-world scenarios that may complicate treatment from a physician and patient perspective. Statements were drafted based on the selected articles and relevant discussion.
Consensus among panel members was achieved using a modified Delphi technique.21 Consensus was defined as agreement among at least a supermajority of 7/10 of the experts participating in the panel. If 7/10 agreement could not be achieved, the proposal was re-discussed among panel members and modified until agreement was achieved.
RESULTS
The process yielded 7 statements that received supermajority (≥7/10) approval regarding the current understanding of AKs and associated management considerations.
Consensus Statements
Actinic keratoses may progress into invasive squamous cell carcinomas.
Multiple studies have determined that there is a risk that AKs can progress to invasive SCC. However, data are limited regarding the exact proportion that may progress, with estimations varying between 0.025% and 16%,22 though the risk appears to increase over time.11 These findings are further compounded by
Consensus Statements
Actinic keratoses may progress into invasive squamous cell carcinomas.
Multiple studies have determined that there is a risk that AKs can progress to invasive SCC. However, data are limited regarding the exact proportion that may progress, with estimations varying between 0.025% and 16%,22 though the risk appears to increase over time.11 These findings are further compounded by
