TY - JOUR

T1 - Structured expert consensus on actinic keratosis

T2 - treatment algorithm focusing on daylight PDT

AU - Calzavara-Pinton, Piergiacomo

AU - Hædersdal, Merete

AU - Barber, Kirk

AU - Basset-Seguin, Nicole

AU - Del Pino Flores, María Emilia

AU - Foley, Peter

AU - Galimberti, Gaston

AU - Gerritsen, Rianne

AU - Gilaberte, Yolanda

AU - Ibbotson, Sally

AU - Peris, Ketty

AU - Sapra, Sheetal

AU - Sotiriou, Elena

AU - Torezan, Luis

AU - Ulrich, Claas

AU - Guillemot, Jonathan

AU - Hendrich, Janek

AU - Szeimies, Rolf Markus

PY - 2017

Y1 - 2017

N2 - 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 lesiondirected 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.

AB - 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 lesiondirected 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.

KW - Actinic keratosis

KW - Consensus

KW - Delphi methodology

KW - Treatment algorithm

U2 - 10.1177/1203475417702994

DO - 10.1177/1203475417702994

M3 - Review

C2 - 28406719

AN - SCOPUS:85021683712

VL - 21

SP - 3S-16S

JO - Journal of Cutaneous Medicine and Surgery

JF - Journal of Cutaneous Medicine and Surgery

SN - 1203-4754

IS - 1_suppl

ER -