Article, 2024

European consensus‐based interdisciplinary guideline for diagnosis, treatment and prevention of actinic keratoses, epithelial UV‐induced dysplasia and field cancerization on behalf of European Association of Dermato‐Oncology, European Dermatology Forum, European Academy of Dermatology and Venereology and Union of Medical Specialists (Union Européenne des Médecins Spécialistes)

Journal of the European Academy of Dermatology and Venereology, ISSN 1468-3083, 0926-9959, Volume 38, 6, Pages 1024-1047, 10.1111/jdv.19897

Contributors

Kandolf, Lidija (Corresponding author) [1] [2] Peris, Ketty 0000-0003-1957-6600 [3] [4] Malvehy, Josep [5] Mosterd, Klara [6] [7] Heppt, Markus Vincent 0000-0003-4603-1825 [8] [9] Fargnoli, Maria Concetta 0000-0002-7249-2556 [10] Berking, Carola 0000-0003-0229-8931 [8] [9] Arenberger, Petr 0000-0002-4800-5877 [11] Bylaite-Bucinskiene, Matilda [12] Del Marmol, Veronique [13] [14] Dirschka, Thomas [15] [16] Dréno, Brigitte 0000-0001-5574-5825 [17] Forsea, Ana‐Maria [18] Harwood, Catherine Anne 0000-0002-1375-0965 [19] Hauschild, Axel [20] Heerfordt, Ida Marie 0000-0002-6130-875X [21] Kauffman, Roland [22] Kelleners‐Smeets, Nicole [6] [7] Lallas, Aimilios 0000-0002-7193-0964 [23] Lebbé, Celeste 0000-0002-5854-7290 [24] Leiter, Ulrike M 0000-0002-8019-1577 [25] Longo, Caterina [26] Mijuskovic, Željko P 0000-0003-0924-1719 [1] [2] Pellacani, Giovanni [27] Puig, Susana [5] Saiag, Philippe 0000-0002-6500-3507 [28] Situm, Mirna 0000-0003-0316-7466 [29] Stockfleth, Eggert [30] Salavastru, Carmen Maria [18] Stratigos, Alexander [31] Zalaudek, Iris [32] Garbe, Claus [25] European Association of Dermato‐Oncology, European Dermatology Forum

Affiliations

  1. [1] Military Medical Academy
    2. [NORA names: Serbia; Europe, Non-EU];
  2. [2] University of Defence
    3. [NORA names: Serbia; Europe, Non-EU];
  3. [3] Agostino Gemelli University Polyclinic
    4. [NORA names: Italy; Europe, EU; OECD];
  4. [4] Catholic University of the Sacred Heart
    5. [NORA names: Italy; Europe, EU; OECD];
  5. [5] August Pi i Sunyer Biomedical Research Institute
    6. [NORA names: Spain; Europe, EU; OECD];

Abstract

A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology, the European Dermatology Forum, the European Academy of Dermatology and Venereology, and the European Union of Medical Specialists was formed to develop European recommendations on AK diagnosis and treatment, based on current literature and expert consensus. This guideline addresses the epidemiology, diagnostics, risk stratification and treatments in immunocompetent as well as immunosuppressed patients. Actinic keratoses (AK) are potential precursors of cutaneous squamous cell carcinoma (cSCC) and display typical histopathologic and immunohistochemical features of this malignancy in an early stage. They can develop into cSSC in situ and become invasive in a low percentage of cases. AK is the most frequent neoplasia in white populations, frequently occurring within a cancerous field induced by ultraviolet radiation. Since it cannot be predicted, which lesion will progress to cSCC and when treatment is usually recommended. The diagnosis of AK and field cancerization is made by clinical examination. Dermatoscopy, confocal microscopy, optical coherence tomography or line-field confocal-OCT can help in the differential diagnosis of AK and other skin neoplasms. A biopsy is indicated in clinically and/or dermatoscopically suspicious and/or treatment-refractory lesions. The choice of treatment depends on patients' and lesion characteristics. For single non-hyperkeratotic lesions, the treatment can be started upon patient's request with destructive treatments or topical treatments. For multiple lesions, field cancerization treatment is advised with topical treatments and photodynamic therapy. Preventive measures such as sun protection, self-examination and repeated field cancerization treatments of previously affected skin areas in high-risk patients are advised.

Keywords

AK diagnosis, CSSC, European, European Academy, European Academy of Dermatology, European Association, European Association of Dermato-Oncology, European Dermatology Forum, European Union, European Union of Medical Specialists, European recommendations, Venereology, actinic keratoses, affected skin areas, area, association, behalf, biopsy, cancer, cancer field, cancer treatment, carcinoma, cases, cell carcinoma, characteristics, clinical examination, coherence tomography, collaboration, collaboration of multidisciplinary experts, confocal microscopy, consensus, cutaneous squamous cell carcinoma, dermato-oncology, dermatology, dermatoscopy, destructive treatment, diagnosis, diagnosis of AK, diagnostics, differential diagnosis, dysplasia, early stages, epidemiology, examination, expert consensus, experts, features, field, field cancerization, forum, frequent neoplasia, guidelines, high-risk patients, immunohistochemical features, immunosuppressed patients, interdisciplinary guidelines, keratoses, lesion characteristics, lesions, literature, low percentage, low percentage of cases, malignancy, measurements, medical specialists, microscopy, multidisciplinary experts, multiple lesions, neoplasia, neoplasms, optical coherence tomography, patient's request, patients, percentage of cases, photodynamic therapy, population, precursor, precursor of cutaneous squamous cell carcinoma, prevention, prevention of actinic keratoses, preventive measures, protection, radiation, recommendations, requests, risk, risk stratification, self-examination, skin, skin areas, skin neoplasms, specialists, squamous cell carcinoma, stage, stratification, sun, sun protection, therapy, tomography, topical treatment, treatment, ultraviolet radiation, white population

Funders

  • British Skin Foundation
  • National Institute for Health and Care Research
  • Netherlands Organisation for Health Research and Development
  • Merck (Germany)
  • Medical Research Council
  • Wellcome Trust

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