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Leiter U, Heppt MV, Steeb T, Alter M, Amaral T, Bauer A, Bechara FG, Becker JC, Breitbart EW, Breuninger H, Diepgen T, Dirschka T, Eigentler T, El Gammal AKS, Felcht M, Flaig MJ, Follmann M, Fritz K, Grabbe S, Greinert R, Gutzmer R, Hauschild A, Hillen U, Ihrler S, John SM, Kofler L, Koelbl O, Krause-Bergmann A, Kraywinkel K, Krohn S, Langer T, Loquai C, Löser CR, Mohr P, Nashan D, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Voelter-Mahlknecht S, Vordermark D, Weichenthal M, Welzel J, Wermker K, Wiegand S, Garbe C, Berking C. S3-Leitlinie "Aktinische Keratose und Plattenepithelkarzinom der Haut" - Update 2023, Teil 2: Epidemiologie und Ätiologie, Diagnostik, Therapie des invasiven Plattenepithelkarzinoms der Haut, Nachsorge und Prävention: S3 guideline "actinic keratosis and cutaneous squamous cell carcinoma" - update 2023, part 2: epidemiology and etiology, diagnostics, surgical and systemic treatment of cutaneous squamous cell carcinoma (cSCC), surveillance and prevention. J Dtsch Dermatol Ges 2023; 21:1422-1434. [PMID: 37946644 DOI: 10.1111/ddg.15256_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 08/18/2023] [Indexed: 11/12/2023]
Abstract
ZusammenfassungAktinische Keratosen (AK) sind häufige Hautveränderungen bei hellhäutigen Menschen mit dem Potenzial, in ein kutanes Plattenepithelkarzinom (PEK) überzugehen. Beide Erkrankungen können mit erheblicher Morbidität verbunden sein und stellen eine große Krankheitslast insbesondere in der älteren Bevölkerung dar. Um einen evidenzbasierten Rahmen für die klinische Entscheidungsfindung zu schaffen, wurde die S3‐Leitlinie "Aktinische Keratose und kutanes Plattenepithelkarzinom" aktualisiert und um die Themen Plattenepithelkarzinom in situ (Morbus Bowen) und Cheilitis actinica, die Manifestation der AK am Lippenrot, erweitert. Die Leitlinie richtet sich dabei an Dermatologen, Allgemeinmediziner, HNO‐Ärzte, Chirurgen, Onkologen, Radiologen und Strahlentherapeuten in Klinik und Praxis sowie an andere medizinische Fachgebiete, politische Entscheidungsträger und Versicherungsgesellschaften, die sich mit der Diagnose und Behandlung von Patienten mit nicht‐melanozytärem Hautkrebs befassen. Für Patienten und deren Angehörige existiert eine gesonderte Patientenleitlinie. In diesem Teil behandeln wir die Themen Epidemiologie und Ätiologie, Diagnostik, Therapie des invasiven Plattenepithelkarzinoms der Haut, Nachsorge und Prävention.
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Affiliation(s)
- Ulrike Leiter
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Markus V Heppt
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
| | - Theresa Steeb
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
| | - Mareike Alter
- Universitätsklinik für Dermatologie, Allergologie, Venerologie und Phlebologie, Johannes Wesling Klinikum, Ruhr-Universität Bochum Campus Minden
| | - Teresa Amaral
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Falk G Bechara
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Ruhr-Universität Bochum
| | - Jürgen C Becker
- Translationale Hautkrebsforschung (TSCR), DKTK Essen/Düsseldorf, Universitätsmedizin Essen
| | | | - Helmut Breuninger
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Thomas Diepgen
- Institut für Klinische Sozialmedizin, Universität Heidelberg
| | | | - Thomas Eigentler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin
| | | | - Moritz Felcht
- Zentrum für Dermatochirurgie, St. Josefskrankenhaus Heidelberg GmbH, Heidelberg
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim
| | - Michael J Flaig
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München
| | - Markus Follmann
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e.V., Berlin
| | - Klaus Fritz
- Zentrum für Dermatologie, Laser und Ästhetische Medizin, Landau
| | - Stephan Grabbe
- Hautklinik der Universitätsmedizin, Johannes Gutenberg Universität Mainz
| | | | - Ralf Gutzmer
- Universitätsklinik für Dermatologie, Allergologie, Venerologie und Phlebologie, Johannes Wesling Klinikum, Ruhr-Universität Bochum Campus Minden
| | - Axel Hauschild
- Hautklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Uwe Hillen
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin
| | | | - Swen Malte John
- Abteilung Dermatologie und Umweltmedizin, Universität Osnabrück, Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück
| | - Lukas Kofler
- Studienzentrum Operative Dermatologie, Universitäts-Hautklinik, Eberhard-Karls-Universität, Tübingen
| | - Oliver Koelbl
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Regensburg
| | - Albrecht Krause-Bergmann
- Klinik für Unfall- und Wiederherstellungschirurgie, Orthopädie, Plastische-, Ästhetische- und Handchirurgie, Sektion für Plastische-, Ästhetische- und Handchirurgie, Gütersloh
| | | | - Steffen Krohn
- Deutsche Gesetzliche Unfallversicherung e.V. (DGUV), Berlin
| | - Thomas Langer
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e.V., Berlin
| | - Carmen Loquai
- Klinikum Bremen-Ost, Klinik für Dermatologie, Dermatochirurgie, Dermatoonkologie und Allergologie, Hautkrebszentrum Bremen
| | - Christoph R Löser
- Hautklinik, Hauttumorzentrum, Klinikum Ludwigshafen gGmbH, Ludwigshafen
| | - Peter Mohr
- Elbe Kliniken Stade Buxtehude, Klinikum Buxtehude
| | | | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Institut für Medizinisches Wissensmanagement, c/o Philipps Universität Marburg
| | - Christina Pfannenberg
- Klinik für Diagnostische und Interventionelle Radiologie, Eberhard-Karls-Universität Tübingen
| | - Carmen Salavastru
- Klinik für Kinderdermatologie, Onkologische Dermatologie - Forschungseinheit, Colentina Universitätsklinikum, Bucharest, "Carol Davila" Universitätsmedizin, Bukarest, Rumänien
| | - Lutz Schmitz
- CentroDerm Wuppertal, Heinz-Fangman-Straße 57, Wuppertal
| | - Eggert Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Ruhr-Universität Bochum
| | | | | | - Susanne Voelter-Mahlknecht
- Institut für Arbeitsmedizin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin
| | - Dirk Vordermark
- Universitätsklinik für Strahlentherapie, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale
| | | | - Julia Welzel
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg Medizincampus Süd, Augsburg
| | - Kai Wermker
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Plastische und Ästhetische Operationen, Klinikum Osnabrück
| | - Susanne Wiegand
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Leipzig
| | - Claus Garbe
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Carola Berking
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
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Leiter U, Heppt MV, Steeb T, Alter M, Amaral T, Bauer A, Bechara FG, Becker JC, Breitbart EW, Breuninger H, Diepgen T, Dirschka T, Eigentler T, ElGammal AKS, Felcht M, Flaig MJ, Follmann M, Fritz K, Grabbe S, Greinert R, Gutzmer R, Hauschild A, Hillen U, Ihrler S, John SM, Kofler L, Koelbl O, Krause-Bergmann A, Kraywinkel K, Krohn S, Langer T, Loquai C, Löser CR, Mohr P, Nashan D, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Voelter-Mahlknecht S, Vordermark D, Weichenthal M, Welzel J, Wermker K, Wiegand S, Garbe C, Berking C. S3 guideline "actinic keratosis and cutaneous squamous cell carcinoma" - update 2023, part 2: epidemiology and etiology, diagnostics, surgical and systemic treatment of cutaneous squamous cell carcinoma (cSCC), surveillance and prevention. J Dtsch Dermatol Ges 2023; 21:1422-1433. [PMID: 37840404 DOI: 10.1111/ddg.15256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 08/18/2023] [Indexed: 10/17/2023]
Abstract
Actinic keratosis (AK) are common lesions in light-skinned individuals that can potentially progress to cutaneous squamous cell carcinoma (cSCC). Both conditions may be associated with significant morbidity and constitute a major disease burden, especially among the elderly. To establish an evidence-based framework for clinical decision making, the guideline "actinic keratosis and cutaneous squamous cell carcinoma" was updated and expanded by the topics cutaneous squamous cell carcinoma in situ (Bowen's disease) and actinic cheilitis. The guideline is aimed at dermatologists, general practitioners, ear nose and throat specialists, surgeons, oncologists, radiologists and radiation oncologists in hospitals and office-based settings, as well as other medical specialties, policy makers and insurance funds involved in the diagnosis and treatment of patients with AK and cSCC. A separate guideline exists for patients and their relatives. In this part, we will address aspects relating to epidemiology and etiology, diagnostics, surgical and systemic treatment of cutaneous squamous cell carcinoma (cSCC), surveillance and prevention.
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Affiliation(s)
- Ulrike Leiter
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
| | - Theresa Steeb
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
| | - Mareike Alter
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | - Teresa Amaral
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Falk G Bechara
- Department of Dermatology, Venerology, and Allergology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jürgen C Becker
- Translational Skin Cancer Research (TSCR), DKTK Essen/Düsseldorf, University Medicine Essen, Essen, Germany
| | | | - Helmut Breuninger
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Thomas Diepgen
- Institute of Clinical Social Medicine, University Heidelberg, Heidelberg, Germany
| | | | - Thomas Eigentler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | | | - Moritz Felcht
- Department of Dermatosurgery, St. Josefhospital Heidelberg GmbH, Heidelberg, Germany
- Department of Dermatology, Venereology und Allergy, University Medicine Mannheim, Mannheim, Germany
| | - Michael J Flaig
- Department of Dermatology and Allergy, University Hospital, LMU Munich, München, Germany
| | - Markus Follmann
- German Guideline Program in Oncology, German Cancer Society, Berlin, Germany
| | - Klaus Fritz
- Dermatology and Laser Consultation Center, Landau, Germany
| | - Stephan Grabbe
- Department of Dermatology, Mainz University Medical School, Mainz, Germany
| | - Rüdiger Greinert
- Elbe Clinics Stade Buxtehude GmbH, Medical Center Buxtehude, Buxtehude, Germany
| | - Ralf Gutzmer
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Uwe Hillen
- Department of Dermatology & Venerology, Vivantes Hospital Neukölln, Berlin, Germany
| | | | - Swen Malte John
- Department of Dermatology and Environmental Medicine, University of Osnabrueck, Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrueck, Osnabrück, Germany
| | - Lukas Kofler
- Study Center for Dermatosurgery, University Hospital Tuebingen, Eberhard-Karls-University, Tübingen, Germany
| | - Oliver Koelbl
- Clinic and Polyclinic for Radiooncology, University Medical Center Regensburg, Regensburg, Germany
| | - Albrecht Krause-Bergmann
- Clinic for Trauma-, Orthopedics-, and Plastic Surgery, Department for Plastic-, Aesthetic- and Handsurgery, Gütersloh, Germany
| | | | - Steffen Krohn
- German Social Accident Insurance (DGUV), Berlin, Germany
| | - Thomas Langer
- German Guideline Program in Oncology, German Cancer Society, Berlin, Germany
| | - Carmen Loquai
- Department of Dermatology, Medical Center Bremen-Ost, Bremen, Germany
| | - Christoph R Löser
- Skin Hospital, Skin Cancer Center, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Peter Mohr
- Elbe Clinics Stade Buxtehude GmbH, Medical Center Buxtehude, Buxtehude, Germany
| | - Dorothée Nashan
- Department of Dermatology, Klinikum Dortmund, Dortmund, Germany
| | - Monika Nothacker
- Association of the Scientific Medical Societies in Germany (AWMF), Institute for Medical Knowledge Management, c/o Philipps Universität Marburg, Marburg, Germany
| | - Christina Pfannenberg
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Carmen Salavastru
- Pediatric Dermatology Discipline, Dermato-oncology Research Facility, "Colentina" Clinical Hospital, Bucharest 020125, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Rumania
| | | | - Eggert Stockfleth
- Department of Dermatology, Venerology, and Allergology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Rolf-Markus Szeimies
- Department of Dermatology and Allergology, Klinikum Vest GmbH, Recklinghausen, Germany
| | - Claas Ulrich
- Dermatologie am Regierungsviertel, Berlin, Germany
| | - Susanne Voelter-Mahlknecht
- Institute of Occupational Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Dirk Vordermark
- Department of Radiation Oncology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Michael Weichenthal
- Department of Dermatology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Julia Welzel
- Department of Dermatology, University Hospital Augsburg, Augsburg, Germany
| | - Kai Wermker
- Klinikum Osnabrueck, Department for Oral and Maxillofacial Surgery, Plastic and Aesthetic Operations, Osnabrück, Germany
| | - Susanne Wiegand
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Claus Garbe
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
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3
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Heppt MV, Leiter U, Steeb T, Alter M, Amaral T, Bauer A, Bechara FG, Becker JC, Breitbart EW, Breuninger H, Diepgen T, Dirschka T, Eigentler T, El Gammal AKS, Felcht M, Flaig MJ, Follmann M, Fritz K, Grabbe S, Greinert R, Gutzmer R, Hauschild A, Hillen U, Ihrler S, John SM, Kofler L, Koelbl O, Krause-Bergmann A, Kraywinkel K, Krohn S, Langer T, Loquai C, Löser CR, Mohr P, Nashan D, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Voelter-Mahlknecht S, Vordermark D, Weichenthal M, Welzel J, Wermker K, Wiegand S, Garbe C, Berking C. S3-Leitlinie "Aktinische Keratose und Plattenepithelkarzinom der Haut" - Update 2023, Teil 1: Therapie der aktinischen Keratose, Morbus Bowen, Cheilitis actinica, berufsbedingte Erkrankung und Versorgungsstrukturen: S3 guideline "actinic keratosis and cutaneous squamous cell carcinoma"- update 2023, part 1: treatment of actinic keratosis, actinic cheilitis, cutaneous squamous cell carcinoma in situ (Bowen's disease), occupational disease and structures of care. J Dtsch Dermatol Ges 2023; 21:1249-1262. [PMID: 37845050 DOI: 10.1111/ddg.15231_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 07/27/2023] [Indexed: 10/18/2023]
Abstract
ZusammenfassungAktinische Keratosen (AK) sind häufige Hautveränderungen bei hellhäutigen Menschen mit dem Potenzial, in ein kutanes Plattenepithelkarzinom (PEK) überzugehen. Beide Erkrankungen können mit erheblicher Morbidität verbunden sein und stellen eine große Krankheitslast insbesondere in der älteren Bevölkerung dar. Um eine evidenzbasierte Grundlage für die klinische Entscheidungsfindung zu schaffen, wurde die S3‐Leitlinie „Aktinische Keratose und kutanes Plattenepithelkarzinom“ aktualisiert und um die Themen Plattenepithelkarzinom in situ (Morbus Bowen) und Cheilitis actinica, die Manifestation der AK am Lippenrot, erweitert. Die Leitlinie richtet sich dabei an Dermatologen, Allgemeinmediziner, HNO‐Ärzte, Chirurgen, Onkologen, Radiologen und Strahlentherapeuten in Klinik und Praxis sowie an andere medizinische Fachgebiete, politische Entscheidungsträger und Versicherungsgesellschaften, die sich mit der Diagnose und Behandlung von Patienten mit nichtmelanozytärem Hautkrebs befassen. Für Patienten und deren Angehörige existiert eine gesonderte Patientenleitlinie. In diesem Teil behandeln wir die Themen Therapie der aktinischen Keratose, Morbus Bowen, Cheilitis actinica, berufsbedingte Erkrankung an AK und PEK sowie Versorgungsstrukturen.
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Affiliation(s)
- Markus V Heppt
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
| | - Ulrike Leiter
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Theresa Steeb
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
| | - Mareike Alter
- Universitätsklinik für Dermatologie, Allergologie, Venerologie und Phlebologie, Johannes Wesling Klinikum, Ruhr-Universität Bochum Campus Minden
| | - Teresa Amaral
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Falk G Bechara
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Ruhr-Universität Bochum
| | - Jürgen C Becker
- Translationale Hautkrebsforschung (TSCR), DKTK Essen/Düsseldorf, Universitätsmedizin Essen
| | | | - Helmut Breuninger
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Thomas Diepgen
- Institut für Klinische Sozialmedizin, Universität Heidelberg
| | | | - Thomas Eigentler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin
| | | | - Moritz Felcht
- Zentrum für Dermatochirurgie, St. Josefskrankenhaus Heidelberg GmbH, Heidelberg
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim
| | - Michael J Flaig
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München
| | - Markus Follmann
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e.V., Berlin
| | - Klaus Fritz
- Zentrum für Dermatologie, Laser und Ästhetische Medizin, Landau
| | - Stephan Grabbe
- Hautklinik der Universitätsmedizin, Johannes Gutenberg Universität Mainz
| | | | - Ralf Gutzmer
- Universitätsklinik für Dermatologie, Allergologie, Venerologie und Phlebologie, Johannes Wesling Klinikum, Ruhr-Universität Bochum Campus Minden
| | - Axel Hauschild
- Hautklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Uwe Hillen
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin
| | | | - Swen Malte John
- Abteilung Dermatologie und Umweltmedizin, Universität Osnabrück, Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück
| | - Lukas Kofler
- Studienzentrum Operative Dermatologie, Universitäts-Hautklinik, Eberhard-Karls-Universität, Tübingen
| | - Oliver Koelbl
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Regensburg
| | - Albrecht Krause-Bergmann
- Klinik für Unfall- und Wiederherstellungschirurgie, Orthopädie, Plastische-, Ästhetische- und Handchirurgie, Sektion für Plastische-, Ästhetische- und Handchirurgie, Gütersloh
| | | | - Steffen Krohn
- Deutsche Gesetzliche Unfallversicherung e.V. (DGUV), Berlin
| | - Thomas Langer
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e.V., Berlin
| | - Carmen Loquai
- Klinikum Bremen-Ost, Klinik für Dermatologie, Dermatochirurgie, Dermatoonkologie und Allergologie, Hautkrebszentrum Bremen
| | - Christoph R Löser
- Hautklinik, Hauttumorzentrum, Klinikum Ludwigshafen gGmbH, Ludwigshafen
| | - Peter Mohr
- Elbe Kliniken Stade Buxtehude, Klinikum Buxtehude
| | | | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Institut für Medizinisches Wissensmanagement, c/o Philipps Universität Marburg
| | - Christina Pfannenberg
- Klinik für Diagnostische und Interventionelle Radiologie, Eberhard-Karls-Universität Tübingen
| | - Carmen Salavastru
- Klinik für Kinderdermatologie, Onkologische Dermatologie - Forschungseinheit, Colentina Universitätsklinikum, "Carol Davila" Universitätsmedizin, Bucharest, Bukarest, Rumänien
| | - Lutz Schmitz
- CentroDerm Wuppertal, Heinz-Fangman-Straße 57, Wuppertal
| | - Eggert Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Ruhr-Universität Bochum
| | | | | | - Susanne Voelter-Mahlknecht
- Institut für Arbeitsmedizin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin
| | - Dirk Vordermark
- Universitätsklinik für Strahlentherapie, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale
| | | | - Julia Welzel
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg Medizincampus Süd, Augsburg
| | - Kai Wermker
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Plastische und Ästhetische Operationen, Klinikum Osnabrück
| | - Susanne Wiegand
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Leipzig
| | - Claus Garbe
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Carola Berking
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
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4
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Heppt MV, Leiter U, Steeb T, Alter M, Amaral T, Bauer A, Bechara FG, Becker JC, Breitbart EW, Breuninger H, Diepgen T, Dirschka T, Eigentler T, El Gammal AKS, Felcht M, Flaig MJ, Follmann M, Fritz K, Grabbe S, Greinert R, Gutzmer R, Hauschild A, Hillen U, Ihrler S, John SM, Kofler L, Koelbl O, Krause-Bergmann A, Kraywinkel K, Krohn S, Langer T, Loquai C, Löser CR, Mohr P, Nashan D, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Voelter-Mahlknecht S, Vordermark D, Weichenthal M, Welzel J, Wermker K, Wiegand S, Garbe C, Berking C. S3 guideline "actinic keratosis and cutaneous squamous cell carcinoma"- update 2023, part 1: treatment of actinic keratosis, actinic cheilitis, cutaneous squamous cell carcinoma in situ (Bowen's disease), occupational disease and structures of care. J Dtsch Dermatol Ges 2023; 21:1249-1262. [PMID: 37845077 DOI: 10.1111/ddg.15231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 07/27/2023] [Indexed: 10/18/2023]
Abstract
SummaryActinic keratosis (AK) are common lesions in light‐skinned individuals that can potentially progress to cutaneous squamous cell carcinoma (cSCC). Both conditions may be associated with significant morbidity and constitute a major disease burden, especially among the elderly. To establish an evidence‐based framework for clinical decision making, the guideline “actinic keratosis and cutaneous squamous cell carcinoma” was updated and expanded by the topics cutaneous squamous cell carcinoma in situ (Bowen's disease) and actinic cheilitis. The guideline is aimed at dermatologists, general practitioners, ear nose and throat specialists, surgeons, oncologists, radiologists and radiation oncologists in hospitals and office‐based settings, as well as other medical specialties, policy makers and insurance funds involved in the diagnosis and treatment of patients with AK and cSCC. A separate guideline exists for patients and their relatives. In this part, we will address aspects relating to AK, actinic cheilitis, Bowen's disease, occupational disease and care structures.
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Affiliation(s)
- Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
| | - Ulrike Leiter
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Theresa Steeb
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
| | - Mareike Alter
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | - Teresa Amaral
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Falk G Bechara
- Department of Dermatology, Venerology, and Allergology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jürgen C Becker
- Translational Skin Cancer Research (TSCR), DKTK Essen/Düsseldorf, University Medicine Essen, Essen, Germany
| | | | - Helmut Breuninger
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Thomas Diepgen
- Institute of Clinical Social Medicine, University Heidelberg, Heidelberg, Germany
| | | | - Thomas Eigentler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | | | - Moritz Felcht
- Department of Dermatosurgery, St. Josefhospital Heidelberg GmbH, Heidelberg, Germany
- Department of Dermatology, Venereology und Allergy, University Medicine Mannheim, Mannheim, Germany
| | - Michael J Flaig
- Department of Dermatology and Allergy, University Hospital, LMU Munich, München, Germany
| | - Markus Follmann
- German Guideline Program in Oncology, German Cancer Society, Berlin, Germany
| | - Klaus Fritz
- Dermatology and Laser Consultation Center, Landau, Germany
| | - Stephan Grabbe
- Department of Dermatology, Mainz University Medical School, Mainz, Germany
| | - Rüdiger Greinert
- Elbe Clinics Stade Buxtehude GmbH, Medical Center Buxtehude, Buxtehude, Germany
| | - Ralf Gutzmer
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Uwe Hillen
- Department of Dermatology & Venerology, Vivantes Hospital Neukölln, Berlin, Germany
| | | | - Swen Malte John
- Department of Dermatology and Environmental Medicine, University of Osnabrueck, Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrueck, Osnabrück, Germany
| | - Lukas Kofler
- Study Center for Dermatosurgery, University Hospital Tuebingen, Eberhard-Karls-University, Tübingen, Germany
| | - Oliver Koelbl
- Clinic and Polyclinic for Radiooncology, University Medical Center Regensburg, Regensburg, Germany
| | - Albrecht Krause-Bergmann
- Clinic for Trauma-, Orthopedics-, and Plastic Surgery, Department for Plastic-, Aesthetic- and Handsurgery, Gütersloh, Germany
| | | | - Steffen Krohn
- German Social Accident Insurance (DGUV), Berlin, Germany
| | - Thomas Langer
- German Guideline Program in Oncology, German Cancer Society, Berlin, Germany
| | - Carmen Loquai
- Department of Dermatology, Medical Center Bremen-Ost, Bremen, Germany
| | - Christoph R Löser
- Skin Hospital, Skin Cancer Center, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Peter Mohr
- Elbe Clinics Stade Buxtehude GmbH, Medical Center Buxtehude, Buxtehude, Germany
| | - Dorothée Nashan
- Department of Dermatology, Klinikum Dortmund, Dortmund, Germany
| | - Monika Nothacker
- Association of the Scientific Medical Societies in Germany (AWMF), Institute for Medical Knowledge Management, c/o Philipps Universität Marburg, Marburg, Germany
| | - Christina Pfannenberg
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Carmen Salavastru
- Pediatric Dermatology Discipline, Dermato-oncology Research Facility, "Colentina" Clinical Hospital, Bucharest 020125, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Rumania
| | | | - Eggert Stockfleth
- Department of Dermatology, Venerology, and Allergology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Rolf-Markus Szeimies
- Department of Dermatology and Allergology, Klinikum Vest GmbH, Recklinghausen, Germany
| | - Claas Ulrich
- Dermatologie am Regierungsviertel, Berlin, Germany
| | - Susanne Voelter-Mahlknecht
- Institute of Occupational Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Dirk Vordermark
- Department of Radiation Oncology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Michael Weichenthal
- Department of Dermatology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Julia Welzel
- Department of Dermatology, University Hospital Augsburg, Augsburg, Germany
| | - Kai Wermker
- Klinikum Osnabrueck, Department for Oral and Maxillofacial Surgery, Plastic and Aesthetic Operations, Osnabrück, Germany
| | - Susanne Wiegand
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Claus Garbe
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
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5
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Morton CA, Szeimies RM, Braathen LR. Review of the European Society for Photodynamic Therapy (Euro-PDT) Annual Congress 2022. Eur J Dermatol 2023; 33:467-473. [PMID: 38297922 DOI: 10.1684/ejd.2023.4562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
This article reviews the 2022 European Society for Photodynamic Therapy (Euro-PDT) Annual Congress. PDT has been investigated for the treatment of a broad number of oncologic, infectious and inflammatory indications. New studies confirm the potential for wider use of topical PDT for acne and photoaging, as well as several uncommon conditions including tinea capitis, Mycobacterium marinum, cutaneous alternariosis, resistant acral warts, eyelid Bowen's disease, mycosis fungoides, pseudolymphoma, and graft-versus-host disease. Hidradenitis suppurativa patients may also benefit from intra-lesional PDT. Several methods of delivering PDT have been validated, including conventional, daylight and artificial daylight PDT. Light-emitting fabrics have emerged as an innovative solution to the delivery of uniform light over the scalp as well as anatomically-challenging sites, with opportunities now to control and monitor these devices via mobile phone applications. Pre-treatment of patients with thicker, more difficult-to-treat actinic keratoses (AK) with calcitriol appears to be a practical approach to increasing efficacy, although this is associated with increased local skin reactions. Sequential treatment of AK and photoaging with daylight-PDT and injectable NASHA gel indicates that these two therapeutic approaches offer complementary effects. Potential biomarkers may help predict responsiveness of patients with field cancerization and AK receiving daylight PDT. Over-expression of the proto-oncogene, Myc, has been observed in poor responders, whilst the tumour suppressor gene, PTEN, showed under-expression. The potential for use and methods of delivery of topical PDT for dermatological indications continue to expand the enhanced choice of treatment offered to patients.
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Affiliation(s)
- Colin A Morton
- Department of Dermatology, Stirling Community Hospital, Stirling, UK
| | - Rolf-Markus Szeimies
- Department of Dermatology and Allergology, Klinikum Vest GmbH Academic Teaching Hospital, Recklinghausen, Germany
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6
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Szeimies RM, Dirschka T, Fargnoli MC, Gilaberte Y, Hædersdal M, Chavda R, Calzavara-Pinton P. A Review of MAL-PDT for the Treatment Strategy of Actinic Keratosis: Broader Clinical Perspectives Beyond the Data and Guideline Recommendations. Dermatol Ther (Heidelb) 2023:10.1007/s13555-023-00936-w. [PMID: 37300793 DOI: 10.1007/s13555-023-00936-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/04/2023] [Indexed: 06/12/2023] Open
Abstract
Methyl aminolevulinate (MAL) is a topical compound approved for use with photodynamic therapy (PDT) for the treatment of actinic keratosis (AK) and field cancerization in certain countries. There exists a high burden of disease for patients with AK: repeated treatments are required, there is a known risk of progression to keratinocyte carcinoma, and cosmetic appearance is affected. Delivery of PDT using MAL is a flexible treatment strategy available in many forms; red light, daylight, or artificial daylight can be used for illumination, all of which result in high AK clearance rates and low recurrence. MAL-PDT protocols continue to evolve to further improve adherence and treatment outcomes. Here, we used PubMed to search MEDLINE to identify guidelines, consensus recommendations, and studies describing the use of MAL for the treatment of AK. The aim of this targeted review is to consider various MAL-PDT treatment strategies on the basis of published literature, with a focus on personalizing treatment for the heterogeneous AK population.
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Affiliation(s)
- Rolf-Markus Szeimies
- Department of Dermatology and Allergology, Klinikum Vest GmbH Academic Teaching Hospital, Recklinghausen, Germany
| | | | - Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Dermatology Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Yolanda Gilaberte
- Department of Dermatology, Miguel Servet University Hospital, IIS Aragón, Saragossa, Spain
| | - Merete Hædersdal
- Department of Dermatology, Bispebjerg and Frederiksberg Hospitals, Copenhagen University Hospital, Copenhagen, Denmark
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7
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Morton C, Baharlou S, Basset-Seguin N, Calzavara-Pinton P, Dirschka T, Gilaberte Y, Haedersdal M, Hofbauer G, Sapra S, Waalboer-Spuij R, Yip L, Szeimies RM. Expert Recommendations on Facilitating Personalized Approaches to Long-term Management of Actinic Keratosis: The Personalizing Actinic Keratosis Treatment (PAKT) Project. Acta Derm Venereol 2023; 103:adv6229. [PMID: 37289027 DOI: 10.2340/actadv.v103.6229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/25/2023] [Indexed: 06/09/2023] Open
Abstract
Actinic keratoses are pre-malignant skin lesions that require personalized care, a lack of which may result in poor treatment adherence and suboptimal outcomes. Current guidance on personalizing care is limited, notably in terms of tailoring treatment to individual patient priorities and goals and supporting shared decision-making between healthcare professionals and patients. The aim of the Personalizing Actinic Keratosis Treatment panel, comprised of 12 dermatologists, was to identify current unmet needs in care and, using a modified Delphi approach, develop recommendations to support personalized, long-term management of actinic keratoses lesions. Panellists generated recommendations by voting on consensus statements. Voting was blinded and consensus was defined as ≥ 75% voting 'agree' or 'strongly agree'. Statements that reached consensus were used to develop a clinical tool, of which, the goal was to improve understanding of disease chronicity, and the need for long-term, repeated treatment cycles. The tool highlights key decision stages across the patient journey and captures the panellist's ratings of treatment options for attributes prioritized by patients. The expert recommendations and the clinical tool can be used to facilitate patient-centric management of actinic keratoses in daily practice, encompassing patient priorities and goals to set realistic treatment expectations and improve care outcomes.
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Affiliation(s)
- Colin Morton
- Department of Dermatology, NHS Forth Valley, Stirling, United Kingdom.
| | - Samira Baharlou
- Department of Dermatology, Skin Immunology & Immune Tolerance (SKIN) Research Group, Vrije Universiteit Brussel, Brussels, Belgium; Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | | | | | - Yolanda Gilaberte
- Department of Dermatology, Miguel Servet University Hospital, IIS Aragón, Zaragoza, Spain
| | - Merete Haedersdal
- Department of Dermatology, Bispebjerg and Frederiksberg Hospitals, Copenhagen University Hospital, Copenhagen
| | - Günther Hofbauer
- University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Sheetal Sapra
- Oakville Trafalgar Memorial Hospital, Oakville, Canada; Institution of Cosmetic and Laser Surgery, Oakville, Canada
| | | | | | - Rolf-Markus Szeimies
- Department of Dermatology & Allergology, Klinikum Vest GmbH Academic Teaching Hospital, Recklinghausen, Germany
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8
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Szeimies RM, Abels C, Kilic A, Reich H, Berger B, Schulze Zur Wiesche E, Schramm K, Litzka L, Heimstaedt-Muskett S, Masur C. Long-term efficacy and safety of 1% glycopyrronium bromide cream in patients with severe primary axillary hyperhidrosis: Results from a Phase 3b trial. J Eur Acad Dermatol Venereol 2023; 37:823-830. [PMID: 36606529 DOI: 10.1111/jdv.18843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Primary axillary hyperhidrosis (PAHH) strongly affects the patient's quality of life. To date, topical treatment options are limited. One percent glycopyrronium bromide (GPB) showed promising efficacy and safety in a pivotal 4-week Phase 3a study. OBJECTIVES To assess efficacy and safety of topical 1% GPB cream in patients with severe PAHH in a long-term study of 72 weeks versus baseline. METHODS This was a long-term, open-label, Phase 3b trial for 72 weeks including 518 patients with severe PAHH. Patients were treated with 1% GPB cream once daily for 4 weeks, followed by a flexible dosing scheme (min. twice per week, max. once daily). Primary endpoint was the absolute change in sweat production from baseline to week 12. Further study endpoints included assessment of the severity of PAHH and the impact on quality of life. RESULTS Total median sweat production decreased by 119.30 mg (-65.6%, both median) until week 12. Absolute change in sweat production from baseline to week 12 in logarithmic values was statistically significant (p < 0.0001). Patients' quality of life was improved at all study time points compared to baseline, as assessed by Hyperhidrosis Quality of Life Index and Dermatology Life Quality Index (p < 0.0001). Treatment was safe and locally well-tolerated with only few mild to moderate adverse drug reactions (ADRs). Dry mouth and application site erythema were the most common reported ADRs. CONCLUSIONS Treatment with 1% GPB cream over 72 weeks significantly reduces sweat production and improves quality of life in patients with severe PAHH. One percent GPB cream is well-tolerated and provides an effective treatment option for long-term use in patients with severe PAHH.
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Affiliation(s)
| | - Christoph Abels
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany.,Bionorica SE, Neumarkt, Germany
| | - Ana Kilic
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
| | - Hubert Reich
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
| | - Birgit Berger
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
| | | | | | | | | | - Clarissa Masur
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany
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9
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Falkenberg C, Schmitz L, Dicke K, Dervenis V, Szeimies RM, Dirschka T. Pretreatment with ablative fractional carbon dioxide laser improves treatment efficacy in a synergistic PDT protocol for actinic keratoses on the head. Photodiagnosis Photodyn Ther 2021; 34:102249. [PMID: 33711530 DOI: 10.1016/j.pdpdt.2021.102249] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND A recently proposed synergistic photodynamic therapy protocol (s-PDT) combining advantages of both conventional- and daylight-PDT proved to be an effective and almost painless treatment for patients with actinic keratoses (AKs). This study investigated the safety and efficacy of an additional ablative fractional CO2-laser (AFXL) pretreatment. METHODS 28 patients with AKs on the head received s-PDT using 5-aminolevulinic acid. AFXL pretreatment was conducted using the following parameters: pulse energy 8 mJ, spot density 50 spots/cm2, power 30 W, beam size 4-18 mm. Outcome was assessed by AK area and severity index (AKASI) and lesion count (LC) before and 3 months after treatment. Safety was monitored by blood pressure and pulse measurements. Intensity of pain was determined by use of a visual analog scale (VAS). RESULTS Most patients (96.4 %) showed a significant AKASI reduction (P < 0.0001) 3 months after PDT (median AKASI 1.6 [0-2.4]) compared to baseline (5.3 [4-7.75]). Median reduction rate was 75.5 % (61.3 %-100 %). Eleven patients (39.3 %) achieved AKASI 100, three (10.7 %) AKASI 75 and ten (35.7 %) AKASI 50. Blood pressure and pulse did not change significantly throughout treatment. Median VAS for pain during irradiation was 0 (0-0), 0 (0-2) and 0 (0-2) at the beginning, in the meantime and at the end, respectively. Compared to data without AFXL pretreatment, this study showed significantly higher AKASI and LC reduction rates (75.5 % vs. 63.7 % [P = 0.023] and 91.3 % vs. 80.4 % [P = 0.043]). CONCLUSIONS S-PDT with AFXL pretreatment represents a safe and almost painless treatment for patients with AKs on the head and improves treatment efficacy.
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Affiliation(s)
- C Falkenberg
- CentroDerm Clinic, Heinz-Fangman-Straße 57, Wuppertal, Germany; Faculty of Health, University Witten-Herdecke, Alfred-Herrhausen-Straße 50, Witten, Germany.
| | - L Schmitz
- Department of Dermatology, Venereology and Allergology, Ruhr-University, Bochum, Germany; Institute of Dermatopathology, MVZ Corius DermPathBonn, Bonn, Germany
| | - K Dicke
- CentroDerm Clinic, Heinz-Fangman-Straße 57, Wuppertal, Germany; Faculty of Health, University Witten-Herdecke, Alfred-Herrhausen-Straße 50, Witten, Germany
| | - V Dervenis
- CentroDerm Clinic, Heinz-Fangman-Straße 57, Wuppertal, Germany
| | - R M Szeimies
- Clinic for Dermatology and Allergology, Klinikum Vest, Recklinghausen, Germany
| | - T Dirschka
- CentroDerm Clinic, Heinz-Fangman-Straße 57, Wuppertal, Germany; Faculty of Health, University Witten-Herdecke, Alfred-Herrhausen-Straße 50, Witten, Germany
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10
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Ulrich M, Reinhold U, Dominicus R, Aschoff R, Szeimies RM, Dirschka T. Red light photodynamic therapy with BF-200 ALA showed superior efficacy in the treatment of actinic keratosis on the extremities, trunk, and neck in a vehicle-controlled phase III study. J Am Acad Dermatol 2021; 85:1510-1519. [PMID: 33744350 DOI: 10.1016/j.jaad.2021.03.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/19/2021] [Accepted: 03/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Actinic keratoses (AK) may occur in all sun-exposed skin areas. Those occurring outside the head area are generally more resistant to treatment than those on the face. OBJECTIVE To determine efficacy and safety of BF-200 ALA versus vehicle in the treatment of mild-to-severe AK located on extremities, trunk, and neck with red light photodynamic therapy (PDT). METHODS This phase III study had an intra-individual design with 50 patients in 6 centers in Germany. Each patient received a maximum of 2 field-directed PDTs. Clinical end points and 1-year follow-up results were recorded. RESULTS BF-200 ALA was superior to the vehicle with respect to total lesion clearance rates (86.0% vs 32.9%; P < .0001) and patient complete clearance per patient's side (67.3% vs 12.2%, P < .0001). One-year overall lesion recurrence rate was 14.1% versus 27.4% (BF-200 ALA vs vehicle; P = .0068). Patients were more satisfied by the cosmetic outcome of BF-200 ALA/PDT than the vehicle/PDT. Adverse events were consistent with the known safety profile of BF-200 ALA/PDT. LIMITATIONS Small number of severe lesions; limited sample size; unbalanced but representative distribution of AK. CONCLUSION BF-200 ALA showed significantly higher AK clearance rates on extremities, trunk, and neck than the vehicle and was well tolerated.
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Affiliation(s)
| | - Uwe Reinhold
- MVZ Dermatologisches Zentrum Bonn GmbH, Bonn, Germany
| | | | - Roland Aschoff
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Rolf-Markus Szeimies
- Department of Dermatology and Allergology, Klinikum Vest GmbH, Recklinghausen, Germany
| | - Thomas Dirschka
- CentroDerm GmbH, Wuppertal, Germany and Faculty of Health, University Witten-Herdecke, Witten, Germany.
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11
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Karrer S, Szeimies RM, Philipp-Dormston WG, Gerber PA, Prager W, Datz E, Zeman F, Müller K, Koller M. Repetitive Daylight Photodynamic Therapy versus Cryosurgery for Prevention of Actinic Keratoses in Photodamaged Facial Skin: A Prospective, Randomized Controlled Multicentre Two-armed Study. Acta Derm Venereol 2021; 101:adv00355. [PMID: 33313936 PMCID: PMC9309835 DOI: 10.2340/00015555-3717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Actinic keratoses are a chronic condition in ultraviolet-damaged skin, with a risk of progressing to invasive skin cancer. The aim of this study was to investigate the preventive potential of field-directed repetitive daylight photodynamic therapy for actinic keratoses. A randomized trial was performed, including 58 patients with ≥5 actinic keratoses on photodamaged facial skin, who received either 5 full-face sessions of day-light photodynamic therapy within a period of 2 years or lesion-directed cryosurgery. Primary outcome was the mean cumulative number of new actinic keratoses developed between visits 2 and 6 (visit 6 being a follow-up). This outcome was lower after daylight photodynamic therapy (7.7) compared with cryosurgery (10.2), but the difference did not reach significance (–2.5, 95% confidence interval –6.2 to 1.2; p=0.18). Several signs of photoageing (fine lines, pigmentation, roughness, erythema, sebaceous gland hyperplasia) were significantly reduced after daylight photodynamic therapy, but not after cryosurgery. Significantly less pain and fewer side-effects were reported during day-light photodynamic therapy than during cryosurgery. This study found that repetitive daylight photodynamic therapy had photo-rejuvenating effects. However, the prevention of actinic keratoses by this therapy could not be proven in a statistically reliable manner.
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Affiliation(s)
- Sigrid Karrer
- Department of Dermatology, University Hospital Regensburg, DE-93053 Regensburg, Germany. E-mail:
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12
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Heppt MV, Leiter U, Steeb T, Amaral T, Bauer A, Becker JC, Breitbart E, Breuninger H, Diepgen T, Dirschka T, Eigentler T, Flaig M, Follmann M, Fritz K, Greinert R, Gutzmer R, Hillen U, Ihrler S, John SM, Kölbl O, Kraywinkel K, Löser C, Nashan D, Noor S, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Welzel J, Wermker K, Berking C, Garbe C. S3 guideline for actinic keratosis and cutaneous squamous cell carcinoma - short version, part 1: diagnosis, interventions for actinic keratoses, care structures and quality-of-care indicators. J Dtsch Dermatol Ges 2020; 18:275-294. [PMID: 32130773 DOI: 10.1111/ddg.14048] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Actinic keratoses (AK) are common lesions in light-skinned individuals that can potentially progress to cutaneous squamous cell carcinoma (cSCC). Both conditions may be associated with significant morbidity and constitute a major disease burden, especially among the elderly. To establish an evidence-based framework for clinical decision making, the guideline "actinic keratosis and cutaneous squamous cell carcinoma" was developed using the highest level of methodology (S3) according to regulations issued by the Association of Scientific Medical Societies in Germany (AWMF). The guideline is aimed at dermatologists, general practitioners, ENT specialists, surgeons, oncologists, radiologists and radiation oncologists in hospitals and office-based settings as well as other medical specialties involved in the diagnosis and treatment of patients with AK and cSCC. The guideline is also aimed at affected patients, their relatives, policy makers and insurance funds. In the first part, we will address aspects relating to diagnosis, interventions for AK, care structures and quality-of-care indicators.
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Affiliation(s)
- Markus V Heppt
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian University Munich, Munich, Germany.,Department of Dermatology, Universitätsklinikum Erlangen, Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Ulrike Leiter
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Theresa Steeb
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian University Munich, Munich, Germany
| | - Teresa Amaral
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Andrea Bauer
- Department of Dermatology, Carl Gustav Carus University Medical Center, Dresden, Germany
| | - Jürgen C Becker
- Department of Dermatology, German Cancer Consortium (DKTK), Essen University Medical Center, Essen, and German Cancer Research Center, Heidelberg, Germany
| | | | - Helmut Breuninger
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Thomas Diepgen
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology, University Hospital, Germany
| | - Thomas Dirschka
- CentroDerm Clinic and Medical Faculty of Witten Herdecke University, Wuppertal, Germany
| | - Thomas Eigentler
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Michael Flaig
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian University Munich, Munich, Germany
| | | | - Klaus Fritz
- Dermatology and Laser Center, Landau, Germany
| | | | - Ralf Gutzmer
- Skin Cancer Center Hannover, Department of Dermatology and Allergy, Hanover Medical School, Hanover, Germany
| | - Uwe Hillen
- Department of Dermatology and Venereology, Vivantes Medical Center, Berlin-Neukölln, Germany
| | | | - Swen Malte John
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Oliver Kölbl
- Department of Radiation Oncology, Regensburg University Medical Center, Regensburg, Germany
| | | | - Christoph Löser
- Skin Hospital, Skin Cancer Center, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Dorothée Nashan
- Department of Dermatology, Klinikum Dortmund gGmbH, Dortmund, Germany
| | - Seema Noor
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Monika Nothacker
- Association of Scientific Medical Societies in Germany (AWMF), Berlin, Germany
| | - Christina Pfannenberg
- Department of Diagnostic and Interventional Radiology, University Medical Center, Tübingen, Germany
| | | | - Lutz Schmitz
- Department of Dermatology, Ruhr University of Bochum, Bochum, Germany
| | - Eggert Stockfleth
- Department of Dermatology, Ruhr University of Bochum, Bochum, Germany
| | - Rolf-Markus Szeimies
- Department of Dermatology, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany
| | - Claas Ulrich
- Department of Dermatology, Charité University Medical Center, Berlin, Germany
| | - Julia Welzel
- Department of Dermatology and Allergology, University of Augsburg, Augsburg, Germany
| | - Kai Wermker
- Department of Oral and Maxillofacial Surgery, Klinikum Osnabrück, Osnabrück, Germany
| | - Carola Berking
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian University Munich, Munich, Germany.,Department of Dermatology, Universitätsklinikum Erlangen, Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Claus Garbe
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
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Berman B, Bukhalo M, Hanke CW, Jarner MF, Larsson T, Siegel DM, Skov T, Szeimies RM. Efficacy and safety of ingenol disoxate gel in field treatment of actinic keratosis on full face, scalp or large area (250 cm2) on the chest: results of four phase 3 randomized controlled trials. Dermatol Online J 2020. [DOI: 10.5070/d32610050459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Berman B, Bukhalo M, Hanke CW, Jarner MF, Larsson T, Siegel DM, Skov T, Szeimies RM. Efficacy and safety of ingenol disoxate gel in field treatment of actinic keratosis on full face, scalp or large area (250 cm2) on the chest: results of four phase 3 randomized controlled trials. Dermatol Online J 2020; 26:13030/qt7677c8r4. [PMID: 33147665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 06/11/2023] Open
Abstract
INTRODUCTION Actinic keratosis (AK) is a skin condition arising from chronic exposure to ultraviolet light and may lead to the development of malignancies. This trial aimed to evaluate efficacy and safety of ingenol disoxate gel (IngDsx, 0.018% for face/chest [FC]; 0.037% for scalp [S]), versus vehicle. METHODS Four identical phase 3 trials in patients with AK on the full face/up to 250cm2 of chest or full balding scalp, with an initial 8-week period and 12-month follow-up, were conducted. FC and S trials were pooled for analysis. The primary endpoint was complete clearance at Week 8. RESULTS Across trials, 616 patients were randomized to FC and 626 to S, with 410 and 420 assigned to receive IngDsx, respectively. In the FC and S trials, 25.9% and 24.5% of patients in the IngDsx group, respectively, achieved the primary endpoint. IngDsx was relatively well tolerated. During extended follow-up, there were more identified non-melanoma skin malignancies in the IngDsx group than vehicle group; HR: 2.38 (95% CI: 1.28, 4.41). CONCLUSION Treatment with IngDsx was superior to vehicle on all clinical endpoints, patient-reported and cosmetic outcomes. During the 12-month follow-up, slightly increased skin malignancies in the treatment area were identified, potentially due to unintentional detection bias.
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Affiliation(s)
- Brian Berman
- Center for Clinical and Cosmetic Research, Aventura, FL.
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Peris K, Fargnoli MC, Garbe C, Kaufmann R, Bastholt L, Seguin NB, Bataille V, Del Marmol V, Dummer R, Harwood CA, Hauschild A, Höller C, Haedersdal M, Malvehy J, Middleton MR, Morton CA, Nagore E, Stratigos AJ, Szeimies RM, Tagliaferri L, Trakatelli M, Zalaudek I, Eggermont A, Grob JJ. Response to: Comment on 'Diagnosis and treatment of basal cell carcinoma: European consensus-based interdisciplinary guidelines'. Eur J Cancer 2020; 140:154-157. [PMID: 32978037 DOI: 10.1016/j.ejca.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Ketty Peris
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Maria C Fargnoli
- Department of Dermatology, University of L'Aquila, L'Aquila, Italy
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard-Karls University, Tuebingen, Germany
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Germany
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Denmark
| | | | - Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London, SE1 7EH, UK
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich and University Zurich, Switzerland
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Axel Hauschild
- Department of Dermatology, University of Kiel, Kiel, Germany
| | - Christoph Höller
- Department of Dermatology, Medical University of Vienna, Austria
| | - Merete Haedersdal
- Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark
| | - Josep Malvehy
- Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, Barcelona & CIBERER, Barcelona, Spain
| | - Mark R Middleton
- Department of Oncology, University of Oxford, Old Road Campus, Oxford, OX3 9DU, UK
| | | | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncologia, Valencia, Spain
| | - Alexander J Stratigos
- 1(st)Department of Dermatology- Venereology, National and Kapodistrian University of Athens, School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Rolf-Markus Szeimies
- Clinic for Dermatology and Allergology, Klinikum Vest GmbH Teaching Hospital, Recklinghausen, Germany
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche Ed Ematologiche, Rome, Italy
| | - Myrto Trakatelli
- Second Department of Dermatology, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Iris Zalaudek
- Dermatology Clinic, University of Trieste, Trieste, Italy
| | | | - Jean J Grob
- University Department of Dermatology, Marseille, France
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Peris K, Fargnoli MC, Garbe C, Kaufmann R, Bastholt L, Seguin NB, Bataille V, Del Marmol V, Dummer R, Harwood CA, Hauschild A, Höller C, Haedersdal M, Malvehy J, Middleton MR, Morton CA, Nagore E, Stratigos AJ, Szeimies RM, Tagliaferri L, Trakatelli M, Zalaudek I, Eggermont A, Grob JJ. Comment on 'Diagnosis and treatment of basal cell carcinoma: European consensus-based interdisciplinary guidelines'. Eur J Cancer 2020; 131:100-103. [PMID: 32241671 DOI: 10.1016/j.ejca.2020.02.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Ketty Peris
- Institute of Dermatology, Catholic University of the Sacred Heart, IRCCS, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Maria C Fargnoli
- Department of Dermatology, University of L'Aquila, L'Aquila, Italy
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard-Karls University, Tuebingen, Germany
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Germany
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Denmark
| | | | - Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London, SE17EH, UK
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich and University Zurich, Switzerland
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Axel Hauschild
- Department of Dermatology, University of Kiel, Kiel, Germany
| | - Christoph Höller
- Department of Dermatology, Medical University of Vienna, Austria
| | - Merete Haedersdal
- Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark
| | - Josep Malvehy
- Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, CIBERER, Barcelona, Spain
| | - Mark R Middleton
- Department of Oncology, University of Oxford, Old Road Campus, Oxford, OX39DU, UK
| | | | - Eduardo Nagore
- Department of Dermatology, InstitutoValenciano de Oncologia, Valencia, Spain
| | - Alexander J Stratigos
- 1stDepartment of Dermatology- Venereology, National and Kapodistrian University of Athens, School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Rolf-Markus Szeimies
- Clinic for Dermatology and Allergology, Klinikum Vest GmbH Teaching Hospital, Recklinghausen, Germany
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Rome, Italy
| | - Myrto Trakatelli
- Second Department of Dermatology, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Iris Zalaudek
- Dermatology Clinic, University of Trieste, Trieste, Italy
| | - Alexander Eggermont
- Cancer Institute, GustaveRoussy Cancer Campus, Grand Paris, 94805, Villejuif, France
| | - Jean J Grob
- University Department of Dermatology, Marseille, France
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Leiter U, Heppt MV, Steeb T, Amaral T, Bauer A, Becker JC, Breitbart E, Breuninger H, Diepgen T, Dirschka T, Eigentler T, Flaig M, Follmann M, Fritz K, Greinert R, Gutzmer R, Hillen U, Ihrler S, John SM, Kölbl O, Kraywinkel K, Löser C, Nashan D, Noor S, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Welzel J, Wermker K, Garbe C, Berking C. S3‐Leitlinie „Aktinische Keratose und Plattenepithelkarzinom der Haut“ – Kurzfassung, Teil 2: Epidemiologie, chirurgische und systemische Therapie des Plattenepithelkarzinoms, Nachsorge, Prävention und Berufskrankheit. J Dtsch Dermatol Ges 2020; 18:400-413. [PMID: 32291932 DOI: 10.1111/ddg.14072_g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ulrike Leiter
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Markus V Heppt
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians--Universität München, München.,Klinik für Dermatologie, Universitätsklinikum Erlangen
| | - Theresa Steeb
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians--Universität München, München
| | - Teresa Amaral
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Andrea Bauer
- Klinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Dresden
| | | | | | - Helmut Breuninger
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Thomas Diepgen
- Institut für klinische Sozialmedizin, Universität Heidelberg
| | | | - Thomas Eigentler
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Michael Flaig
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians--Universität München, München
| | | | | | | | - Ralf Gutzmer
- Klinik für Dermatologie, Medizinische Hochschule Hannover
| | - Uwe Hillen
- Klinik für Dermatologie, Vivantes Klinikum Neukölln, Berlin
| | | | - Swen Malte John
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück
| | - Oliver Kölbl
- Klinik für Strahlentherapie, Universitätsklinikum Regensburg
| | | | | | | | - Seema Noor
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Berlin
| | - Christina Pfannenberg
- Klinik für Diagnostische unter Interventionelle Radiologie, Eberhard-Karls-Universität Tübingen
| | | | - Lutz Schmitz
- Klinik für Dermatologie, Ruhr-Universität Bochum
| | | | | | - Claas Ulrich
- Klinik für Dermatologie, Charité - Universitätsmedizin Berlin
| | | | - Kai Wermker
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Klinikum Osnabrück
| | - Claus Garbe
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Carola Berking
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians--Universität München, München.,Klinik für Dermatologie, Universitätsklinikum Erlangen
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Heppt MV, Leiter U, Steeb T, Amaral T, Bauer A, Becker JC, Breitbart E, Breuninger H, Diepgen T, Dirschka T, Eigentler T, Flaig M, Follmann M, Fritz K, Greinert R, Gutzmer R, Hillen U, Ihrler S, John SM, Kölbl O, Kraywinkel K, Löser C, Nashan D, Noor S, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Welzel J, Wermker K, Berking C, Garbe C. S3‐Leitlinie „Aktinische Keratose und Plattenepithelkarzinom der Haut“ – Kurzfassung, Teil 1: Diagnostik, Interventionen bei aktinischen Keratosen, Versorgungsstrukturen und Qualitätsindikatoren. J Dtsch Dermatol Ges 2020; 18:275-294. [PMID: 32130769 DOI: 10.1111/ddg.14048_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Markus V Heppt
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, München.,Hautklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
| | - Ulrike Leiter
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Theresa Steeb
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, München
| | - Teresa Amaral
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Dresden
| | - Jürgen C Becker
- Klinik für Dermatologie, Deutsches Konsortium für translationale Krebsforschung (DKTK), Universitätsklinikum Essen und Deutsches Krebsforschungszentrum (DKFZ), Heidelberg
| | - Eckhard Breitbart
- Arbeitsgemeinschaft Dermatologische Prävention (ADP), e.V., Buxtehude
| | - Helmut Breuninger
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Thomas Diepgen
- Institut für Klinische Sozialmedizin, Universität Heidelberg, Heidelberg
| | | | - Thomas Eigentler
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Michael Flaig
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, München
| | | | | | - Rüdiger Greinert
- Arbeitsgemeinschaft Dermatologische Prävention (ADP), e.V., Buxtehude
| | - Ralf Gutzmer
- Hauttumorzentrum Hannover, Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Hannover
| | - Uwe Hillen
- Klinik für Dermatologie, Vivantes Klinikum Neukölln, Berlin
| | | | - Swen Malte John
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Osnabrück
| | - Oliver Kölbl
- Klinik für Strahlentherapie, Universitätsklinikum Regensburg, Regensburg
| | | | - Christoph Löser
- Hautklinik, Hauttumorzentrum, Klinikum Ludwigshafen, Ludwigshafen
| | | | - Seema Noor
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
| | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Berlin
| | - Christina Pfannenberg
- Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Tübingen
| | | | - Lutz Schmitz
- Klinik für Dermatologie, Ruhr-Universität Bochum, Bochum
| | | | | | - Claas Ulrich
- Klinik für Dermatologie, Charité - Universitätsmedizin Berlin, Berlin
| | - Julia Welzel
- Klinik für Dermatologie und Allergologie, Universität sklinikum Augsburg, Augsburg
| | - Kai Wermker
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Klinikum Osnabrück, Osnabrück
| | - Carola Berking
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, München.,Hautklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
| | - Claus Garbe
- Klinik für Dermatologie, Eberhard-Karls-Universität Tübingen, Tübingen
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Peris K, Fargnoli MC, Garbe C, Kaufmann R, Bastholt L, Seguin NB, Bataille V, Marmol VD, Dummer R, Harwood CA, Hauschild A, Höller C, Haedersdal M, Malvehy J, Middleton MR, Morton CA, Nagore E, Stratigos AJ, Szeimies RM, Tagliaferri L, Trakatelli M, Zalaudek I, Eggermont A, Grob JJ. Diagnosis and treatment of basal cell carcinoma: European consensus–based interdisciplinary guidelines. Eur J Cancer 2019; 118:10-34. [DOI: 10.1016/j.ejca.2019.06.003] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
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Mordon S, Vignion-Dewalle AS, Abi-Rached H, Thecua E, Lecomte F, Vicentini C, Deleporte P, Béhal H, Kerob D, Hommel T, Duhamel A, Szeimies RM, Mortier L. The conventional protocol vs. a protocol including illumination with a fabric-based biophotonic device (the Phosistos protocol) in photodynamic therapy for actinic keratosis: a randomized, controlled, noninferiority clinical study. Br J Dermatol 2019; 182:76-84. [PMID: 31021404 DOI: 10.1111/bjd.18048] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Topical photodynamic therapy (PDT) using methyl aminolaevulinate is a noninvasive treatment option suitable to treat clinical and subclinical actinic keratosis (AK) over a large area (field cancerization). The most widely used, conventional protocol in Europe includes illumination with a red-light lamp. This illumination commonly causes pain, and patients often cannot complete the treatment. OBJECTIVES The aims of this paper are twofold. The first aim is to introduce a novel protocol, the Phosistos protocol (P-PDT), which includes illumination with a fabric-based biophotonic device. The second and major aim is to assess the noninferiority, in terms of efficacy for PDT of AK, of P-PDT compared with the conventional protocol (C-PDT). METHODS A randomized, controlled, multicentre, intraindividual clinical study was conducted. Forty-six patients with grade I-II AK of the forehead and scalp were treated with P-PDT on one area (280 AK lesions) and with C-PDT on the contralateral area (280 AK lesions). The primary end point was the lesion complete response (CR) rate at 3 months, with an absolute noninferiority margin of -10%. Secondary end points included pain scores, incidence of adverse effects and cosmetic outcome. RESULTS Three months following treatment, the lesion CR rate of P-PDT was noninferior to that of C-PDT (79·3% vs. 80·7%, respectively; absolute difference -1·6%; one-sided 95% confidence interval -4·5% to infinity). The noninferiority of P-PDT to C-PDT in terms of the lesion CR rate remained at the 6-month follow-up (94·2% vs. 94·9%, respectively; absolute difference -0·6%; one-sided 95% confidence interval -2·7% to infinity). Moreover, the pain score at the end of illumination was significantly lower for P-PDT than for C-PDT (mean ± SD 0·3 ± 0·6 vs. 7·4 ± 2·3; P < 0·001). CONCLUSIONS P-PDT is noninferior to C-PDT in terms of efficacy for treating AK of the forehead and scalp and resulted in much lower pain scores and fewer adverse effects. What's already known about this topic? Topical photodynamic therapy using methyl aminolaevulinate is effective for treating actinic keratosis. In Europe, the conventional protocol involves illumination with a red-light lamp. Unfortunately, pain is often experienced by patients undergoing this protocol. An alternative protocol that uses daylight illumination has recently been shown to be as effective as the conventional protocol while being nearly painless. However, this alternative protocol can be conducted only in suitable weather conditions. What does this study add? The Phosistos protocol is demonstrated to be as effective as the conventional protocol, nearly as painless as the daylight protocols and suitable year round for treatment of actinic keratosis.
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Affiliation(s)
- S Mordon
- University of Lille, INSERM, CHU Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000, Lille, France
| | - A S Vignion-Dewalle
- University of Lille, INSERM, CHU Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000, Lille, France
| | - H Abi-Rached
- University of Lille, INSERM, CHU Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000, Lille, France.,Department of Dermatology, CHU Lille, F-59000, Lille, France
| | - E Thecua
- University of Lille, INSERM, CHU Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000, Lille, France
| | - F Lecomte
- University of Lille, INSERM, CHU Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000, Lille, France
| | - C Vicentini
- University of Lille, INSERM, CHU Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000, Lille, France.,Department of Dermatology, CHU Lille, F-59000, Lille, France
| | - P Deleporte
- University of Lille, INSERM, CHU Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000, Lille, France
| | - H Béhal
- University of Lille, CHU Lille, EA 2694 - Santé Publique: Epidémiologie et Qualité des Soins, Unité de Biostatistiques, F-59000, Lille, France
| | - D Kerob
- Galderma International SAS, F-92927, La Défense, France
| | - T Hommel
- Department of Dermatology and Allergology, Klinikum Vest GmbH, D-45657, Recklinghausen, Germany
| | - A Duhamel
- University of Lille, CHU Lille, EA 2694 - Santé Publique: Epidémiologie et Qualité des Soins, Unité de Biostatistiques, F-59000, Lille, France
| | - R M Szeimies
- Department of Dermatology and Allergology, Klinikum Vest GmbH, D-45657, Recklinghausen, Germany
| | - L Mortier
- University of Lille, INSERM, CHU Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000, Lille, France.,Department of Dermatology, CHU Lille, F-59000, Lille, France
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21
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Tizek L, Schielein MC, Rüth M, Szeimies RM, Philipp-Dormston WG, Braun SA, Hecker C, Eberlein B, Biedermann T, Zink A. Interest in Skin Cancer in Urban Populations: A Retrospective Analysis of Google Search Terms in Nine Large German Cities. Acta Derm Venereol 2019; 99:797-804. [PMID: 31073622 DOI: 10.2340/00015555-3214] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Skin cancer is a major public health issue, which could be reduced through prevention programmes. How-ever, prevention utilization is not very prevalent. It is therefore important to understand individuals' interest in skin cancer. Google AdWords Keyword Planner was used to identify the search volume of terms relating to skin cancer in 9 German cities between July 2014 and June 2018. From a total of 1,203 identified keywords, 1,047 search terms were related to skin cancer, which had a search volume of 3,460,980 queries for the study period. Most terms referred to "identifying skin cancer". For melanoma, the number of Google searches per 100,000 inhabitants correlated with the cancer registry data for melanoma incidence rates (men: r = 0.810, women: r = 0.569). Assessment of this data for the different cities further enabled identification of regional variations, which could help to identify areas with a high need for targeted prevention campaigns.
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Affiliation(s)
- Linda Tizek
- Department of Dermatology and Allergy, Technical University of Munich,Biedersteiner Str. 29, DE-80802 Munich, Germany
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22
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Vignion-Dewalle AS, Abi Rached H, Thecua E, Lecomte F, Deleporte P, Béhal H, Hommel T, Duhamel A, Szeimies RM, Mortier L, Mordon S. A New Light-Emitting, Fabric-Based Device for Photodynamic Therapy of Actinic Keratosis: Protocol for a Randomized, Controlled, Multicenter, Intra-Individual, Phase II Noninferiority Study (the Phosistos Study). JMIR Res Protoc 2019; 8:e12990. [PMID: 31025953 PMCID: PMC6658310 DOI: 10.2196/12990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Actinic keratosis (AK) is a common early in situ skin carcinoma caused by long-term sun exposure and usually develops on sun-exposed skin areas. Left untreated, AK may progress to squamous cell carcinoma. To prevent such risk, most clinicians routinely treat AK. Therapy options for AK include cryotherapy, topical treatments, curettage, excision surgery, and photodynamic therapy (PDT). OBJECTIVE The aim of this study is to assess the noninferiority, in terms of efficacy at 3 months, of a PDT protocol involving a new light-emitting device (PDT using the Phosistos protocol [P-PDT]) compared with the conventional protocol (PDT using the conventional protocol [C-PDT]) in the treatment of AK. METHODS In this randomized, controlled, multicenter, intra-individual, phase II noninferiority clinical study, subjects with AK of the forehead and scalp are treated with P-PDT on one area and with C-PDT on the contralateral area. In both areas, lesions are prepared and methyl aminolevulinate (MAL) is applied. Thirty minutes after MAL application, the P-PDT area is exposed to red light at low irradiance (1.3 mW/cm2) for 2.5 hours so that a light dose of 12 J/cm2 is achieved. In the control area (C-PDT area), a 37 J/cm2 red light irradiation is performed 3 hours after MAL application. Recurrent AK at 3 months is retreated. The primary end point is the lesion complete response rate at 3 months. Secondary end points include pain scores at 1 day, local tolerance at 7 days, lesion complete response rate at 6 months, cosmetic outcome at 3 and 6 months, and patient-reported quality of life and satisfaction throughout the study. A total of 45 patients needs to be recruited. RESULTS Clinical investigations are complete: 46 patients were treated with P-PDT on one area (n=285 AK) and with C-PDT on the contralateral area (n=285 AK). Data analysis is ongoing, and statistical results will be available in the first half of 2019. CONCLUSIONS In case of noninferiority in efficacy and superiority in tolerability of P-PDT compared with C-PDT, P-PDT could become the treatment of choice for AK. TRIAL REGISTRATION ClinicalTrials.gov NCT03076892; https://clinicaltrials.gov/ct2/show/NCT03076892 (Archived by WebCite at http://www.webcitation.org/779qqVKek). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/12990.
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Affiliation(s)
- Anne-Sophie Vignion-Dewalle
- U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, Université de Lille, INSERM, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Henry Abi Rached
- U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, Université de Lille, INSERM, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Dermatology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Elise Thecua
- U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, Université de Lille, INSERM, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Fabienne Lecomte
- U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, Université de Lille, INSERM, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Pascal Deleporte
- U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, Université de Lille, INSERM, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Hélène Béhal
- EA 2694 - Santé Publique: épidémiologie et qualité des soins, Unité de Biostatistiques, Université de Lille, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Theresa Hommel
- Department of Dermatology and Allergology, Klinikum Vest GmbH, Recklinghausen, Germany
| | - Alain Duhamel
- EA 2694 - Santé Publique: épidémiologie et qualité des soins, Unité de Biostatistiques, Université de Lille, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Rolf-Markus Szeimies
- Department of Dermatology and Allergology, Klinikum Vest GmbH, Recklinghausen, Germany
| | - Laurent Mortier
- U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, Université de Lille, INSERM, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Dermatology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Serge Mordon
- U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, Université de Lille, INSERM, Centre Hospitalier Universitaire de Lille, Lille, France
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23
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Schmitz L, Gupta G, Stücker M, Doerler M, Gambichler T, Welzel J, Szeimies RM, Bierhoff E, Stockfleth E, Dirschka T. Evaluation of two histological classifications for actinic keratoses - PRO classification scored highest inter-rater reliability. J Eur Acad Dermatol Venereol 2019; 33:1092-1097. [PMID: 30887613 DOI: 10.1111/jdv.15580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 02/26/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Actinic keratoses (AKs) can histologically be classified by the extent of atypical keratinocytes throughout the epidermis or their pattern of basal proliferation. Currently, no data on the inter-rater reliability of both scores is available. OBJECTIVE To evaluate the inter-rater reliability of the two classification schemes; histological grade (AK I-III) and basal proliferation (PRO I-III). METHODS Histological images of 54 AKs were classified by 21 independent dermatopathologists with regard to basal proliferation (PRO I-III), histological grade (AK I-III) and assumed risk of progression into invasive carcinoma. RESULTS Overall, of the 54 AKs 16.7% (9/54) were classified as AK I, 66.7% (36/54) as AK II, and 16.7% (9/54) as AK III. With regards to basal growth pattern, 25.9% (14/54) were classified as PRO I, 42.6% (23/54) as PRO II, and 31.5% (17/54) as PRO III. We observed a highly significant inter-rater reliability for PRO-grading (P < 0.001) which was higher than for AK-grading (Kendall's W coefficient: AK = 0.488 vs. PRO = 0.793). We found substantial agreement for assumed progression risk for AKs with worsening basal proliferation (k = 0.759) compared to moderate agreement (k = 0.563) for different AK-gradings. CONCLUSIONS Histological classification of basal growth pattern (PRO) showed higher inter-rater reliability compared to the established classification of atypical keratinocytes throughout epidermal layers. Moreover, experienced dermatopathologists considered basal proliferation to be more important in terms of progression risk than upwards directed growth patterns. It should be considered to classify AKs according to their basal proliferation pattern (PRO I-III).
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Affiliation(s)
- L Schmitz
- Department of Dermatology, Venereology and Allergology, Ruhr University, Bochum, Germany
| | - G Gupta
- Department of Dermatology, University Hospital Monklands, Lanarkshire, UK.,School of Medicine, University of Glasgow, Glasgow, UK
| | - M Stücker
- Department of Dermatology, Venereology and Allergology, Ruhr University, Bochum, Germany
| | - M Doerler
- Department of Dermatology, Venereology and Allergology, Ruhr University, Bochum, Germany
| | - T Gambichler
- Department of Dermatology, Venereology and Allergology, Ruhr University, Bochum, Germany
| | - J Welzel
- Department of Dermatology and Allergology, General Hospital Augsburg, Augsburg, Germany
| | - R M Szeimies
- Department of Dermatology and Allergology, Vest Hospital, Academic Teaching Hospital University of Bochum, Recklinghausen, Germany
| | - E Bierhoff
- Heinz-Werner-Seifert-Institute of Dermatopathology, Bonn, Germany
| | - E Stockfleth
- Department of Dermatology, Venereology and Allergology, Ruhr University, Bochum, Germany
| | - T Dirschka
- CentroDerm Clinic, Wuppertal, Germany.,Faculty of Health, University Witten-Herdecke, Witten, Germany
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24
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Datz E, Zeman F, Koller M, Szeimies RM, Berneburg M, Landthaler M, Bosserhoff AK, Karrer S. Phototherapy-induced elevation of serum level of melanoma inhibitory activity. Photodermatol Photoimmunol Photomed 2019; 35:255-260. [PMID: 30815924 DOI: 10.1111/phpp.12461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/27/2019] [Accepted: 02/25/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Phototherapy is a frequently used treatment modality for a variety of dermatologic diseases. UV radiation has different effects on the skin, for example increased production and release of cytokines and other proteins, and is involved in the initiation and progression of skin cancer. Objective of this clinical trial was to investigate potential systemic effects of UV phototherapy on cytokine profiles in blood. METHODS In a prospective, mono-centric, one-armed study, the serum levels of the melanoma tumour marker "melanoma inhibitory activity" (MIA), Il-1α, Il-4, Il-6, Il-10, TNF-α and IFN-γ of 115 patients with different skin diseases were compared before and 24-48 hours as well as 2-4 weeks after the first phototherapy with PUVA (psoralen and ultraviolet A), UVA or UVB, or both. Data were analysed using linear mixed models. RESULTS Estimated marginal means of MIA levels were 6.05 ng/mL (95%-CI: 5.37-6.72, range: 2.83-14.49) before the first treatment, which had significantly increased to 6.79 ng/mL 2-4 weeks after the first phototherapy (CI 95%: 6.12-7.47, range: 3.09-15.45; P = 0.0042). MIA levels 2-4 weeks after the first phototherapy were significantly higher than 24-48 hours after the first phototherapy (P = 0.0083). 2-4 weeks after the first treatment, TNF-α levels had decreased significantly (P = 0.033) more in patients with psoriasis who had responded well to phototherapy than in patients unresponsive to treatment. Serum levels of the other cytokines had not changed significantly. CONCLUSIONS Short-term phototherapy significantly increased the serum levels of the melanoma tumour marker MIA. The potential clinical relevance of these findings (ie an increased risk of melanoma) is unclear and should be further investigated.
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Affiliation(s)
- Elisabeth Datz
- Department of Dermatology, University Medical Centre Regensburg, Regensburg, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Medical Centre Regensburg, Regensburg, Germany
| | - Michael Koller
- Centre for Clinical Studies, University Medical Centre Regensburg, Regensburg, Germany
| | - Rolf-Markus Szeimies
- Department of Dermatology and Allergology, Klinikum Vest GmbH, Recklinghausen, Germany
| | - Mark Berneburg
- Department of Dermatology, University Medical Centre Regensburg, Regensburg, Germany
| | - Michael Landthaler
- Department of Dermatology, University Medical Centre Regensburg, Regensburg, Germany
| | - Anja K Bosserhoff
- Institute of Biochemistry, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Sigrid Karrer
- Department of Dermatology, University Medical Centre Regensburg, Regensburg, Germany
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25
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Abstract
Introduction Actinic keratosis is regarded as a chronic disease of the skin and, although fluctuating, is chronically progressive. Approval of new products for the treatment of actinic keratosis requires the use of a standard methodology in clinical trials which emphasize complete clearance of all actinic keratoses in a treatment field in a defined time span and the evaluation of long-term efficacy in terms of recurrence rate among completely cleared patients. Methods Analysis of data from six previously published clinical trials in patients with actinic keratosis. Results There was poor agreement over a period of 1 month in the complete clearance endpoint. This variation in assessment renders recurrence in cleared patients invalid as the estimate of long-term efficacy. Furthermore, complete clearance was shown to depend heavily on the number of baseline actinic keratoses. Conclusion The main endpoints presently in use for the assessment of short- and long-term efficacy of actinic keratosis field-directed therapy, namely, complete clearance and recurrence rate, are obsolete and should be replaced by the percentage reduction in actinic keratosis count or the absolute actinic keratosis count. Funding LEO Pharma A/S.
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Affiliation(s)
| | | | | | - Brian Berman
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, USA.,Center for Clinical and Cosmetic Research, Aventura, FL, USA
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26
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Torezan L, Grinblat B, Haedersdal M, Valente N, Festa-Neto C, Szeimies RM. A randomized split-scalp study comparing calcipotriol-assisted methyl aminolaevulinate photodynamic therapy (MAL-PDT) with conventional MAL-PDT for the treatment of actinic keratosis. Br J Dermatol 2018; 179:829-835. [PMID: 29476546 DOI: 10.1111/bjd.16473] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Topical photodynamic therapy (PDT) is an approved treatment for actinic keratosis (AK). To enhance the efficacy of PDT for AKs, physical and chemical pretreatments have been suggested. OBJECTIVES To compare the efficacy and safety of the combination of topical calcipotriol (CAL) before methyl aminolaevulinate (MAL)-PDT for AKs of the scalp vs. conventional MAL-PDT in a randomized controlled clinical trial. METHODS Twenty patients with multiple AKs on the scalp were randomized to receive conventional MAL-PDT with previous curettage on one side of the scalp and CAL-assisted MAL-PDT once a day for 15 days before illumination on the other side. After 3 months, patients were evaluated for clearance of AKs, side-effects and histopathology before and after the procedure. Protoporphyrin IX (PpIX) fluorescence was measured before and after illumination on both sides. RESULTS All 20 patients completed the study. Overall AK clearance rates were 92·1% and 82·0% for CAL-PDT and conventional PDT, respectively (P < 0·001). Grade 1 AKs showed similar response rates for both sides (P = 0·055). However, grade II AKs showed more improvement on the CAL-PDT side (90%) than on the MAL-PDT side (63%) (P < 0·001). Before illumination, PpIX fluorescence intensity was higher on the CAL-assisted side (P = 0·048). The treatment was more painful on the CAL-PDT side, although well tolerated. The mean visual analogue scale score was 5·4 ± 1·4 on the CAL-PDT side and 4·0 ± 0·69 on the conventional MAL-PDT side (P = 0·001). Side-effects such as erythema (P = 0·019), oedema (P = 0·002) and crusts (P < 0·001) were more pronounced on the CAL-assisted side. Histopathological analyses were obtained from five patients and both sides showed improved keratinocyte atypia following PDT, with slightly more improvement on the CAL-assisted side. CONCLUSIONS CAL-assisted PDT proved to be safe and more effective than conventional MAL-PDT for the treatment of AKs on the scalp. CAL pretreatment increased PpIX accumulation within the skin and may have enhanced the efficacy in this first human trial.
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Affiliation(s)
- L Torezan
- Department of Dermatology, Universidade de São Paulo, Hospital das Clínicas, São Paulo, Brazil
| | - B Grinblat
- Department of Dermatology, Universidade de São Paulo, Hospital das Clínicas, São Paulo, Brazil
| | - M Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - N Valente
- Department of Dermatology, Universidade de São Paulo, Hospital das Clínicas, São Paulo, Brazil
| | - C Festa-Neto
- Department of Dermatology, Universidade de São Paulo, Hospital das Clínicas, São Paulo, Brazil
| | - R M Szeimies
- Department of Dermatology and Allergology, Klinikum Vest GmbH, Recklinghausen, Germany
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27
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Diepgen TL, Kresken J, Krutmann J, Merk HF, Senger E, Surber C, Szeimies RM. Commentary on the "Evidence- and Consensus-Based (S3) Guidelines for the Treatment of Actinic Keratosis" Published by the International League of Dermatological Societies in Cooperation with the European Dermatology Forum. Skin Pharmacol Physiol 2018; 31:144-146. [PMID: 29614495 DOI: 10.1159/000486687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 11/19/2022]
Abstract
In 2015, the International League of Dermatological Societies and the European Dermatology Forum published a guideline for the treatment of actinic keratosis, which is classified as an evidence- and consensus-based S3 guideline. From the point of view of the GD Task Force "Licht.Hautkrebs.Prävention," an interdisciplinary expert panel of the Society for Dermopharmacy for the prevention and treatment of skin cancer, this guideline reveals strengths and weaknesses but, in summary, does not meet the claim for an evidence- and consensus-based S3 guideline.
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Affiliation(s)
- Thomas L Diepgen
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Jean Krutmann
- IUF - Leibniz Institute for Environmental Research, Düsseldorf, Germany
| | - Hans F Merk
- Department of Dermatology and Allergology, University Hospital, Aachen, Germany
| | | | - Christian Surber
- Departments of Dermatology Clinics, University Hospitals, Basel, Switzerland.,Departments of Dermatology Clinics, University Hospitals, Zurich, Switzerland
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28
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Philipp-Dormston WG, Müller K, Novak B, Strömer K, Termeer C, Hammann U, Glutsch JW, Krähn-Senftleben G, Lübbert H, Koller M, Szeimies RM. Patient-reported health outcomes in patients with non-melanoma skin cancer and actinic keratosis: results from a large-scale observational study analysing effects of diagnoses and disease progression. J Eur Acad Dermatol Venereol 2018; 32:1138-1146. [PMID: 29150868 PMCID: PMC6032898 DOI: 10.1111/jdv.14703] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 11/07/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Non-melanoma skin cancer (NMSC) and actinic keratosis (AK) are very common among fair-skinned individuals. A disease continuum from AK to squamous cell carcinoma (SCC) has been frequently postulated. AK and NMSC may influence quality of life (QL) of patients, and it can be suspected that disease progression entails a QL reduction. The purpose of this study was to document QL in patients with NMSC and AK using the health-outcome questionnaire EQ-5D-5L. METHODS The study was designed as a non-interventional, prospective, cross-sectional study. Patients with AK, SCC, basal cell carcinoma (BCC) or multiple diagnoses were enrolled in this study in 29 dermatological centres across Germany. Patients were asked to complete the EQ-5D-5L (compromising EQ Index and EQ VAS), and the dermatologists provided diagnosis, disease history and treatment data. RESULTS A total of 1184 patients were enrolled and diagnosed as follows: 73% AK, 49% BCC and 17% SCC. 66% had a single diagnosis, 28% two different diagnoses and 6% three different diagnoses. QL was strongly associated with patients' diagnosis. Patients with a single AK diagnosis had significantly higher mean EQ VAS (78) than patients with BCC (74), SCC (72), and BCC plus SCC (69), P < 0.050. When the effects of disease progression were calculated, patients with AK plus SCC reported significantly less mean EQ VAS (71) than patients with a single AK diagnosis (78), P < 0.011. CONCLUSIONS While rarely being imminently life-threatening, NMSC and AK have an impact on QL as quantified by the EQ-5D-5L. This impact is associated with diagnosis (AK vs. NMSC) and clinical progression (AK vs. AK plus SCC). Both lead to a clear decline in QL. This shows that disease progression is perceived and judged as detrimental by patients and that AK and NMSC should be diligently treated to preserve and restore QL.
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Affiliation(s)
| | - K Müller
- Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - B Novak
- Biofrontera Pharma GmbH, Leverkusen, Germany
| | - K Strömer
- Professional Association of German Dermatologists (BVDD), Mönchengladbach, Germany
| | - C Termeer
- Hautarztpraxis am Löwenmarkt, Dematology Practice, Stuttgart, Germany
| | - U Hammann
- Hautarztpraxis Dr. med. Urte Hammann, Dermatology Practice, Stade, Germany
| | - J W Glutsch
- Hautarztpraxis Dr. med. J. W. Glutsch, Dermatology Practice, Karlsruhe, Germany
| | | | - H Lübbert
- Biofrontera Pharma GmbH, Leverkusen, Germany
| | - M Koller
- Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - R M Szeimies
- Department of Dermatology and Allergology, Vest Clinic, Recklinghausen, Germany
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Müller K, Karrer S, Szeimies RM, Steinbauer J, Kohl E, Steinbauer D, Zeman F, Berneburg M, Koller M. Quality of life assessment in patients with nonmelanoma skin cancer - psychometric validation of the EORTC QLQ-C30 questionnaire. J Dtsch Dermatol Ges 2017; 15:1090-1100. [DOI: 10.1111/ddg.13357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/06/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Karolina Müller
- Center for Clinical Studies; University Medical Center Regensburg; Regensburg Germany
| | - Sigrid Karrer
- Department of Dermatology; University Medical Center Regensburg; Regensburg Germany
| | - Rolf-Markus Szeimies
- Department of Dermatology and Allergology; Klinikum Vest; Recklinghausen Germany
| | - Julia Steinbauer
- Dermatology Practice; Regensburger Straße 36a; 93133 Burglengenfeld Germany
| | - Elisabeth Kohl
- Department of Dermatology; University Medical Center Regensburg; Regensburg Germany
| | - Dominik Steinbauer
- General Medicine Practice; Kallmünzer Straße 2; 93133 Burglengenfeld Germany
| | - Florian Zeman
- Center for Clinical Studies; University Medical Center Regensburg; Regensburg Germany
| | - Mark Berneburg
- Department of Dermatology; University Medical Center Regensburg; Regensburg Germany
| | - Michael Koller
- Center for Clinical Studies; University Medical Center Regensburg; Regensburg Germany
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30
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Müller K, Karrer S, Szeimies RM, Steinbauer J, Kohl E, Steinbauer D, Zeman F, Berneburg M, Koller M. Beurteilung der Lebensqualität bei Patienten mit nicht-melanozytärem Hautkrebs - psychometrische Validierung des EORTC QLQ-C30-Fragebogens. J Dtsch Dermatol Ges 2017. [DOI: 10.1111/ddg.13357_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Karolina Müller
- Zentrum für Klinische Studien; Universitätsklinikum Regensburg; Regensburg Deutschland
| | - Sigrid Karrer
- Klinik und Poliklinik für Dermatologie; Universitätsklinikum Regensburg; Regensburg Deutschland
| | - Rolf-Markus Szeimies
- Klinik für Dermatologie und Allergologie; Klinikum Vest, Recklinghausen; Deutschland
| | - Julia Steinbauer
- Dermatologische Praxis; Regensburger Straße 36a; 93133 Burglengenfeld Deutschland
| | - Elisabeth Kohl
- Klinik und Poliklinik für Dermatologie; Universitätsklinikum Regensburg; Regensburg Deutschland
| | - Dominik Steinbauer
- Allgemeinmedizinische Praxis; Kallmünzer Straße 2; 93133 Burglengenfeld Deutschland
| | - Florian Zeman
- Zentrum für Klinische Studien; Universitätsklinikum Regensburg; Regensburg Deutschland
| | - Mark Berneburg
- Klinik und Poliklinik für Dermatologie; Universitätsklinikum Regensburg; Regensburg Deutschland
| | - Michael Koller
- Zentrum für Klinische Studien; Universitätsklinikum Regensburg; Regensburg Deutschland
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Calzavara-Pinton P, Hædersdal M, Barber K, Basset-Seguin N, Del Pino Flores ME, Foley P, Galimberti G, Gerritsen R, Gilaberte Y, Ibbotson S, Peris K, Sapra S, Sotiriou E, Torezan L, Ulrich C, Guillemot J, Hendrich J, Szeimies RM. Structured Expert Consensus on Actinic Keratosis: Treatment Algorithm Focusing on Daylight PDT. J Cutan Med Surg 2017. [PMID: 28406719 DOI: 10.1177/1203475417702994.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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.
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Affiliation(s)
| | - Merete Hædersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kirk Barber
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Basset-Seguin
- Department of Dermatology, Hospital Saint-Louis, Université Paris 7, Paris, France
| | | | - Peter Foley
- Department of Medicine (Dermatology), University of Melbourne; St Vincent's Hospital Melbourne, Fitzroy, and Skin & Cancer Foundation, Carlton, Australia
| | - Gaston Galimberti
- Department of Dermatology, School of Medicine, Hospital Italiano, Buenos Aires, Argentina
| | - Rianne Gerritsen
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Sally Ibbotson
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Ketty Peris
- Catholic University of Rome, Fondazione Policlinico Gemelli, Rome, Italy
| | - Sheetal Sapra
- Institute of Cosmetic and Laser Surgery, Oakville, Ontario, Canada
| | - Elena Sotiriou
- First Dermatology Department, Aristotle University, Thessaloniki, Greece
| | - Luis Torezan
- Hospital das Clinicas Faculdade de Medicina Universidade de São Paulo, São Paulo, Brazil
| | | | - Jonathan Guillemot
- Amaris, London, UK.,Universidad San Francisco de Quito USFQ, Escuela de Medicina, Quito, Ecuador
| | | | - Rolf-Markus Szeimies
- Department of Dermatology and Allergology, Vest Hospital, Academic Teaching Hospital University of Bochum, Recklinghausen, Germany
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Calzavara-Pinton P, Hædersdal M, Barber K, Basset-Seguin N, Del Pino Flores ME, Foley P, Galimberti G, Gerritsen R, Gilaberte Y, Ibbotson S, Peris K, Sapra S, Sotiriou E, Torezan L, Ulrich C, Guillemot J, Hendrich J, Szeimies RM. Structured Expert Consensus on Actinic Keratosis: Treatment Algorithm Focusing on Daylight PDT. J Cutan Med Surg 2017; 21:3S-16S. [PMID: 28406719 DOI: 10.1177/1203475417702994] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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.
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Affiliation(s)
| | - Merete Hædersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kirk Barber
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Basset-Seguin
- Department of Dermatology, Hospital Saint-Louis, Université Paris 7, Paris, France
| | | | - Peter Foley
- Department of Medicine (Dermatology), University of Melbourne; St Vincent’s Hospital Melbourne, Fitzroy, and Skin & Cancer Foundation, Carlton, Australia
| | - Gaston Galimberti
- Department of Dermatology, School of Medicine, Hospital Italiano, Buenos Aires, Argentina
| | - Rianne Gerritsen
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Sally Ibbotson
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Ketty Peris
- Catholic University of Rome, Fondazione Policlinico Gemelli, Rome, Italy
| | - Sheetal Sapra
- Institute of Cosmetic and Laser Surgery, Oakville, Ontario, Canada
| | - Elena Sotiriou
- First Dermatology Department, Aristotle University, Thessaloniki, Greece
| | - Luis Torezan
- Hospital das Clinicas Faculdade de Medicina Universidade de São Paulo, São Paulo, Brazil
| | | | - Jonathan Guillemot
- Amaris, London, UK
- Universidad San Francisco de Quito USFQ, Escuela de Medicina, Quito, Ecuador
| | | | - Rolf-Markus Szeimies
- Department of Dermatology and Allergology, Vest Hospital, Academic Teaching Hospital University of Bochum, Recklinghausen, Germany
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Abstract
Complete patient clearance is often required by regulatory agencies for the approval of treatments for actinic keratosis (AK). However, an increasing number of clinicians have challenged the use of this measure in clinical practice and its interpretation. It has been argued that complete patient clearance often underestimates the clinical benefit of a drug and is influenced by a number of key confounding factors, such as number and distribution of lesions, at baseline. Lesions response rate is one alternative which has been suggested as more relevant due to its applicability to clinical practice and closer reflection of the clinical value of the drug. This paper provides an updated perspective on the topic and details the current thinking on the role of complete clearance and lesion response rate in the context of AK. Funding: Galderma.
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Affiliation(s)
- Rolf-Markus Szeimies
- Department of Dermatology and Allergology, Vest Clinic, Recklinghausen, Germany.
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Braathen LR, Morton CA, Szeimies RM. 15th Annual Congress of the European Society for Photodynamic Therapy in Barcelona, Spain, February 12-13th 2016. Dermatol Ther (Heidelb) 2016; 6:443-9. [PMID: 27316645 PMCID: PMC4972732 DOI: 10.1007/s13555-016-0126-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Indexed: 11/29/2022] Open
Abstract
We provide a summary of the presentations made at the recent Euro-PDT annual Congress. Presentations covered developments in topical photodynamic therapy (PDT) pertaining to dermatological applications. Recognizing the high prevalence and chronicity of actinic keratosis, one of the approved indications for PDT, there were recommendations to pursue field therapy to treat clinical and preclinical lesions. A separate section was reserved to review the strong evidence for the use of daylight PDT for actinic keratosis and experience of use of this well tolerated form of PDT was reported from several countries. Several presentations covered the remaining approved uses of topical PDT, Bowen’s disease and basal cell carcinomas, as well as considering its role in so far unapproved indications including photorejuvenation. Funding: Galderma.
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Affiliation(s)
| | - Colin A Morton
- Department of Dermatology, Stirling Community Hospital, Stirling, UK
| | - Rolf-Markus Szeimies
- Department of Dermatology and Allergology, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany
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Philipp-Dormston WG, Karrer S, Petering H, Ulrich C, Dirschka T, Berking C, Lonsdorf AS, Gerber PA, Radakovic S, Hunger RE, Szeimies RM. Daylight PDT with MAL - current data and practical recommendations of an expert panel. J Dtsch Dermatol Ges 2015; 13:1240-9. [DOI: 10.1111/ddg.12807] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
| | - Sigrid Karrer
- Department of Dermatology; University Hospital Regensburg; Regensburg Germany
| | | | | | - Thomas Dirschka
- Centroderm Hospital; Wuppertal and Witten-Herdecke University; Witten Germany
| | - Carola Berking
- Department of Dermatology and Allergology; Munich University Hospital (LMU); Munich Germany
| | - Anke S. Lonsdorf
- Department of Dermatology; Ruprecht Karls University Heidelberg; Heidelberg Germany
| | - Peter Arne Gerber
- Department of Dermatology; University Hospital Düsseldorf; Düsseldorf Germany
| | - Sonja Radakovic
- Department of Dermatology and Dermato-oncology; Division of General Dermatology; Vienna Austria
| | - Robert E. Hunger
- Department of Dermatology; Inselspital Hospital; Bern University; Bern Switzerland
| | - Rolf-Markus Szeimies
- Department of Dermatology and Allergology; Vest Hospital, Teaching Hospital; Recklinghausen Germany
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Philipp-Dormston WG, Karrer S, Petering H, Ulrich C, Dirschka T, Berking C, Lonsdorf AS, Gerber PA, Radakovic S, Hunger RE, Szeimies RM. MAL-PDT mit Tageslicht - Aktuelle Datenlage und praxisorientierte Empfehlungen eines Expertentreffens. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.90_12807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Sigrid Karrer
- Klinik und Poliklinik für Dermatologie; Universitätsklinikum Regensburg
| | | | | | - Thomas Dirschka
- Centroderm Klinik; Wuppertal und Universität Witten-Herdecke; Witten
| | - Carola Berking
- Klinik und Poliklinik für Dermatologie und Allergologie; Klinikum der Universität München (LMU); München
| | | | | | - Sonja Radakovic
- Universitätsklinik für Dermatologie und Dermato-Onkologie, Klinische Abteilung für Allgemeine Dermatologie; Wien Österreich
| | - Robert E. Hunger
- Dermatologische Universitätsklinik, Inselspital; Universität Bern; Schweiz
| | - Rolf-Markus Szeimies
- Klinik für Dermatologie und Allergologie; Klinikum Vest GmbH Akademisches Lehrkrankenhaus; Recklinghausen
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Szeimies RM. A network meta-analysis of the relative efficacy of treatments for actinic keratosis of the face or scalp in Europe. J Eur Acad Dermatol Venereol 2015; 30:1619-20. [PMID: 26081464 DOI: 10.1111/jdv.13206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- R M Szeimies
- Department of Dermatology and Allergology, Vest Clinic, Recklinghausen, Germany
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38
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Szeimies RM, Dirschka T, Prechtl A, Melzer A. Wirksamkeit von niedrig-dosiertem 5-Fluorouracil/Salizylsäure in Abhängigkeit von der Behandlungsdauer bei aktinischen Keratosen. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.12685_suppl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Rolf-Markus Szeimies
- Klinik für Dermatologie und Allergologie; Klinikum Vest GmbH, Knappschaftskrankenhaus Recklinghausen
| | - Thomas Dirschka
- Prof. Dirschka (CentroDerm Klinik Wuppertal, Heinz-Fangman-Str. 57, D-42287 Wuppertal und Universität Witten-Herdecke, Faculty of Health, Alfred-Herrhausen-Str. 50, D-58448 Witten)
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Szeimies RM, Dirschka T, Prechtl A, Melzer A. Efficacy of low-dose 5-fluorouracil/salicylic acid in actinic keratoses in relation to treatment duration. J Dtsch Dermatol Ges 2015; 13:430-8. [DOI: 10.1111/ddg.12685] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rolf-Markus Szeimies
- Department of Dermatology and Allergology, Klinikum Vest GmbH, Knappschaftskrankenhaus Recklinghausen
| | - Thomas Dirschka
- Prof. Dirschka (CentroDerm Klinik Wuppertal, Heinz-Fangman-Str. 57, D-42287 Wuppertal and Universität Witten-Herdecke, Faculty of Health, Alfred-Herrhausen-Str. 50, D-58448 Witten)
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Affiliation(s)
- M Meurer
- Department of Dermatology, Ludwig-Maximilians-Universität, Munich, FRG
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41
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Grinblat BM, Festa Neto C, Sanches JA, Szeimies RM, Oliveira AP, Torezan LAR. Daylight photodynamic therapy for actinic keratoses in São Paulo, Brazil. Photodermatol Photoimmunol Photomed 2014; 31:54-6. [DOI: 10.1111/phpp.12127] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/07/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Beni Moreinas Grinblat
- Department of Dermatology; Hospital das Clinicas; University of Sao Paulo; Sao Paulo Brazil
| | - Cyro Festa Neto
- Department of Dermatology; Hospital das Clinicas; University of Sao Paulo; Sao Paulo Brazil
| | - Jose Antonio Sanches
- Department of Dermatology; Hospital das Clinicas; University of Sao Paulo; Sao Paulo Brazil
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Torezan L, Chaves Y, Niwa A, Sanches JA, Festa-Neto C, Szeimies RM. A Pilot Split-Face Study Comparing Conventional Methyl Aminolevulinate-Photodynamic Therapy (PDT) With Microneedling-Assisted PDT on Actinically Damaged Skin. Dermatol Surg 2013; 39:1197-201. [DOI: 10.1111/dsu.12233] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Szeimies RM, Lischner S, Philipp-Dormston W, Walker T, Hiepe-Wegener D, Feise K, Podda M, Prager W, Kohl E, Karrer S. Photodynamische Therapie zur Hautverjüngung: Behandlungsoptionen - Ergebnisse einer Konsensus-Konferenz des Arbeitskreises Ästhetische Photodynamische Therapie. J Dtsch Dermatol Ges 2013. [DOI: 10.1111/ddg.12119_suppl] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Elisabeth Kohl
- Klinik und Poliklinik für Dermatologie; Universitätsklinikum Regensburg
| | - Sigrid Karrer
- Klinik und Poliklinik für Dermatologie; Universitätsklinikum Regensburg
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44
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Breuninger H, Eigentler T, Bootz F, Hauschild A, Kortmann RD, Wolff K, Stockfleth E, Szeimies RM, Rompel R, Garbe C, Grabbe S. Brief S2k guidelines - Cutaneous squamous cell carcinoma. J Dtsch Dermatol Ges 2013; 11 Suppl 3:37-45, 39-47. [DOI: 10.1111/ddg.12015_7] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Thomas Eigentler
- Department of Dermatology; Tübingen University Hospital; Germany
| | - Friedrich Bootz
- Clinic and Polyclinic for Otolaryngology/Surgery; Bonn University Hospital; Germany
| | - Axel Hauschild
- Department of Dermatology; Kiel University Hospital; Germany
| | | | - Klaus Wolff
- Clinic and Polyclinic for Oral and Maxillofacial Surgery; Klinikum rechts der Isar; Munich Germany
| | - Eggert Stockfleth
- Department of Dermatology, Venereology, and Allergology; Charité - Universitätsmedizin; Berlin Germany
| | - Rolf-Markus Szeimies
- Department of Dermatology and Allergology; Knappschaftskrankenhaus Recklinghausen; Germany
| | | | - Claus Garbe
- Department of Dermatology; Tübingen University Hospital; Germany
| | - Stephan Grabbe
- Department of Dermatology; Mainz University Hospital; Germany
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Breuninger H, Eigentler T, Bootz F, Hauschild A, Kortmann RD, Wolff K, Stockfleth E, Szeimies RM, Rompel R, Garbe C, Grabbe S. S2k Kurzleitlinie - Plattenepithelkarzinom der Haut. J Dtsch Dermatol Ges 2013. [DOI: 10.1111/j.1610-0379.2012.8018_7.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Friedrich Bootz
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde/Chirurgie; Universit≈tsklinikum Bonn
| | | | | | - Klaus Wolff
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie; Klinikum rechts der Isar; München
| | - Eggert Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie, Charité; Berlin
| | - Rolf-Markus Szeimies
- Klinik für Dermatologie und Allergologie; Knappschaftskrankenhaus Recklinghausen
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Szeimies RM, Lischner S, Philipp-Dormston W, Walker T, Hiepe-Wegener D, Feise K, Podda M, Prager W, Kohl E, Karrer S. Photodynamic therapy for skin rejuvenation: treatment options - results of a consensus conference of an expert group for aesthetic photodynamic therapy. J Dtsch Dermatol Ges 2013; 11:632-6. [PMID: 23650971 DOI: 10.1111/ddg.12119] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 03/26/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | | | | | - Maurizio Podda
- Department of Dermatology; Darmstadt Hospital; Darmstadt-Eberstadt
| | | | - Elisabeth Kohl
- Department of Dermatology; University Clinic of Regensburg (all Germany)
| | - Sigrid Karrer
- Department of Dermatology; University Clinic of Regensburg (all Germany)
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47
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Karrer S, Kohl E, Feise K, Hiepe-Wegener D, Lischner S, Philipp-Dormston W, Podda M, Prager W, Walker T, Szeimies RM. Photodynamische Therapie zur Hautverjüngung: Übersicht und publizierte Datenlage - Ergebnisse einer Konsensus-Konferenz des Arbeitskreises Ästhetische Photodynamische Therapie. J Dtsch Dermatol Ges 2013. [DOI: 10.1111/j.1610-0387.2012.08046_suppl.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Karrer S, Kohl E, Feise K, Hiepe-Wegener D, Lischner S, Philipp-Dormston W, Podda M, Prager W, Walker T, Szeimies RM. Photodynamic therapy for skin rejuvenation: review and summary of the literature--results of a consensus conference of an expert group for aesthetic photodynamic therapy. J Dtsch Dermatol Ges 2012. [PMID: 23190505 DOI: 10.1111/j.1610-0387.2012.08046.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Skin rejuvenating effects of photodynamic therapy (PDT) for photoaged skin has been well-documented in several clinical trials. Different photosensitizers (5-aminolevulinic acid, methyl aminolevulinate) and diverse light sources (light-emitting diodes, lasers, intense pulsed light) have been used with promising results. An improvement of lentigines, skin roughness, fine lines and sallow complexion has been achieved with PDT. These clinically evident effects are at least in part due to histologically proven increase of collagen and decrease of elastotic material in the dermis. Effective improvement of photoaged skin, simultaneous treatment and possibly also prevention of actinic keratoses, the possibility of repeated treatments and, in contrast to other procedures, limited and calculable side effects make PDT a promising procedure for skin rejuvenation.
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Affiliation(s)
- Sigrid Karrer
- Department of Dermatology, University Clinic of Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, Germany
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Beek NV, Knuth- Rehr D, Altmeyer P, Assaf C, Babilas P, Bayerl C, Benoit S, Dippel E, Effendy I, Eming R, Fischer M, Glaenz T, Gläser R, Goebeler M, Gollnick H, Götze S, Gross G, Hadaschik E, Herbst R, Hermes B, Homey B, Hunzelmann N, Jünger M, Kapp A, Kern JS, Körber A, Luger T, Mechtel D, Megahed M, Moll I, Peters KP, Pfeiffer C, Ring J, Röcken M, Sárdy M, Seitz CS, Stadler R, Steinbrink K, Sticherling M, Szeimies RM, Tronnier M, Ulrich J, Vogt T, Wagner N, Welzel J, Wenzel J, Wozel G, Zouboulis CC, Zillikens D, Schmidt E. Diagnostik blasenbildender Autoimmundermatosen an deutschen Hautkliniken. J Dtsch Dermatol Ges 2012. [DOI: 10.1111/j.1610-0387.2011.07840_suppl.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Szeimies RM, Torezan L, Niwa A, Valente N, Unger P, Kohl E, Schreml S, Babilas P, Karrer S, Festa-Neto C. Clinical, histopathological and immunohistochemical assessment of human skin field cancerization before and after photodynamic therapy. Br J Dermatol 2012; 167:150-9. [PMID: 22329784 DOI: 10.1111/j.1365-2133.2012.10887.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The field cancerization concept in photodamaged patients suggests that the entire sun-exposed surface of the skin has an increased risk for the development of (pre)-malignant lesions, mainly epithelial tumours. Topical photodynamic therapy (PDT) is a noninvasive therapeutic method for multiple actinic keratosis (AK) with excellent outcome. OBJECTIVES To evaluate the clinical, histological and immunohistochemical changes in human skin with field cancerization after multiple sessions of PDT with methyl-aminolaevulinate (MAL). METHODS Twenty-six patients with photodamaged skin and multiple AK on the face received three consecutive sessions of MAL-PDT with red light (37 J cm(-2)), 1 month apart. Biopsies before and 3 months after the last treatment session were taken from normal-appearing skin on the field-cancerized area. Immunohistochemical stainings were performed for TP-53, procollagen-I, metalloproteinase-1 (MMP-1) and tenascin-C (Tn-C). RESULTS All 26 patients completed the study. The global score for photodamage improved considerably in all patients (P < 0·001). The AK clearance rate was 89·5% at the end of the study. Two treatment sessions were as effective as three MAL-PDT sessions. A significant decrease in atypia grade and extent of keratinocyte atypia was observed histologically (P < 0·001). Also, a significant increase in collagen deposition (P = 0·001) and improvement of solar elastosis (P = 0·002) were noticed after PDT. However, immunohistochemistry showed only a trend for decreased TP-53 expression (not significant), increased procollagen-I and MMP-1 expressions (not significant) and an increased expression of Tn-C (P = 0·024). CONCLUSIONS Clinical and histological improvement in field cancerization after multiple sessions of MAL-PDT is proven. The decrease in severity and extent of keratinocyte atypia associated with a decreased expression of TP-53 suggest a reduced carcinogenic potential of the sun-damaged area. The significant increase of new collagen deposition and the reduction of solar elastosis explain the clinical improvement of photodamaged skin.
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Affiliation(s)
- R M Szeimies
- Department of Dermatology, Regensburg University Hospital, Regensburg, Germany.
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