Management Pearls on the Treatment of Actinic Keratoses and Field Cancerization
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PRACTICAL APPROACH
Management Pearls on the Treatment of Actinic Keratoses and Field Cancerization Jaime Piquero-Casals
. Daniel Morgado-Carrasco . Yolanda Gilaberte .
Rube´n Del Rio . Antonio Macaya-Pascual . Corinne Granger . Jose´ Luis Lo´pez-Estebaranz
Received: June 4, 2020 Ó The Author(s) 2020
ABSTRACT Field cancerization (FC) is a chronic disease involving multiple clinical and subclinical actinic keratoses (AK) on large photo-exposed surfaces with multifocal areas of dysplasia and Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12600221. J. Piquero-Casals (&) Dermik Clinica Dermatolo´gica Multidisciplinar, Barcelona, Spain e-mail: [email protected] D. Morgado-Carrasco Dermatology Department, Hospital Clı´nic de Barcelona, Universitat de Barcelona, Barcelona, Spain Y. Gilaberte Dermatology Department, Instituto de Investigacio´n Sanitaria (IIS) Arago´n, Miguel Servet University Hospital, Zaragoza, Spain R. Del Rio Dermatology Department, Hospital de L’Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain A. Macaya-Pascual Dermatology Department, Hospital Universitari Bellvitge, Barcelona, Spain C. Granger Innovation and Development, ISDIN, Barcelona, Spain J. L. Lo´pez-Estebaranz Dermatology Department, Hospital Universitario Fundacio´n Alcorco´n, Madrid, Spain
precancerous changes. Patients and treatment must be properly monitored and managed to avoid aggravation and progression of the disease. Management of actinic keratoses includes lesion-directed treatments, such as cryotherapy and field-directed therapies. Field-directed therapies may have the potential to address subclinical damage, reduce AK recurrence rates and potentially reduce the risk of squamous cell carcinoma development. Multiple studies have demonstrated the efficacy of field-directed treatments, including 5-fluorouracil, photodynamic therapy, imiquimod, chemical exfoliation with trichloroacetic acid and diclofenac gel, for multiple AK and FC. The choice of therapy should be based on multiple factors, such as efficacy, tolerability, patient risk profile, costs and cosmetic results. Management of AK includes not only treatment but also prevention. Medical devices, such as sunscreens containing liposome-encapsulated DNA repair enzymes, can repair DNA damage associated with chronic UV radiation and reduce the number of new AK lesions. Here we provide therapeutic pearls and expert opinions on the treatment of AK and FC (as monotherapy or in combination) with the overall aim to achieve better, faster, and well-tolerated clinical responses.
Keywords: Actinic keratosis; Chemical peels; Cutaneous field cancerization; Photoaging;
Dermatol Ther (Heidelb)
Photo-carcinogenesis; Photodynamic therapy; Photolyase; Sunscreens; 5-FU Key Summary Points The first step in the management of the patient with multiple actinic keratoses (AK) and field cancerization (FC) is rigorous sun protection. Sunscreens should contain liposomal DNA-photolyase and high UVA and UVB protection filters to reduce s
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