光化性角化病 Actinic keratosis - PubMed 文献(第 3 页)
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Actinic keratoses contiguous with squamous cell carcinomas are mostly non-hyperkeratotic and with severe dysplasia. 与鳞状细胞癌相邻的光化性角化病多为非角化过度型且伴有重度异型增生。
Actinic keratosis (AK) is a precursor of cutaneous squamous cell carcinoma (SCC). No validated parameters can predict which AKs will progress into SCCs, but especially thick AKs are under suspicion. The clinical and histopathological thickness of AKs is strongly correlated. This study aimed to investigate the thicknesses and degree of dysplasia of AKs contiguous with SCCs assuming these AKs represent the AKs that have undergone malignant transformation. Files of the Pathology Department, Hospital of Southern Jutland, Denmark, were reviewed. 111 cases met the inclusion criteria: a skin biopsy containing an invasive SCC. All SCCs merged with an AK at the edge. Degree of dysplasia, epidermal thickness and stratum corneum thicknesses of AKs were measured. All AKs showed severe dysplasia. Most AKs had a stratum corneum thickness under 0.1 mm and an epidermal thickness under 0.5 mm, corresponding to clinically thin and non-hyperkeratotic AKs. Our result suggests malignant progression potential of AKs regardless of thickness.
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Are actinic keratoses really squamous cell cancer? How do we know if they would become malignant? 光化性角化病真的是鳞状细胞癌吗？我们如何知道它们是否会变为恶性？
Actinic keratosis (AK) is a very common skin disease caused by chronic sun exposure. AKs have historically been characterized as being "precancerous" or "premalignant." It is true that these lesions do not possess metastatic potential, because they are confined to the epidermis, but it is not accurate to deem them "premalignant." AK qualifies as a malignant neoplasm, because it also fulfills criteria for malignancy in classic pathology, namely, the capability, or potential, to kill by either destruction of tissue locally or by metastasis widely. In this context, AK is considered now by many a carcinoma in situ and can persist or progress to invasive squamous cell carcinoma (iSCC), which rarely metastasizes. Through this controversy, which speaks to an issue we have been debating for at least a century, we should like to start a constructive debate to reach a unanimous conclusion considering the various theories and points of view in the literature.
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Management of actinic keratosis. 光化性角化病的治疗。
Actinic keratoses are common, often multiple, epidermal lesions found mainly on the sun-exposed skin of fair-skinned middle-aged and older people.(1) Over time, lesions may remain unchanged or may proliferate, regress, reappear or develop into squamous cell carcinoma (SCC).(2) Detectable (spot) lesions are often associated with alteration of the surrounding skin (field) where subclinical lesions might be present.(2) Interventions may target individual or multiple lesions or a whole field.(2) Here, we update our previous review(3) on the prevention and treatment of actinic keratoses, focusing on the licensed treatments most commonly used in the UK and recommended in UK guidelines.
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[Evaluation of the efficacy and concordance between primary and specialized care in the treatment of actinic keratosis using daylight photodynamic therapy monitored by teledermatology]. [远程皮肤科监测下日光光动力疗法治疗光化性角化病的初级保健与专科保健疗效及一致性评估]。
Daylight photodynamic therapy (DL-PDT) is an established option for the treatment of actinic keratoses (AK). In this context, teledermatology has emerged as a promising tool for the follow-up of dermatological patients. This study evaluates the concordance between in-person and teledermatological assessments in the management of AK using DL-PDT. A prospective observational pilot study was conducted on 12 patients treated with DL-PDT. In-person and telematic evaluations were compared regarding the number and severity of lesions, pain, inflammation, efficacy, and cosmetic outcomes. Pearson's correlation coefficients and Cohen's kappa index were used to measure concordance. The study population consisted predominantly of men (91.7%) with a mean age of 73.9 years. Lesions were located on the scalp (66.7%) and cheeks (33.3%). In-person and teledermatological assessments showed highly similar results for the number of grade I and II lesions (4.4 vs. 4.3 and 1.9 vs. 2.0, respectively). Pain and inflammation, evaluated using the Visual Analog Scale (VAS), were minimal during and after treatment (maximum 1.2±0.5 points). The cosmetic outcome was excellent, with a mean score of 9.2±0.9. The concordance between both assessment modalities was perfect (Pearson's correlation coefficient and Cohen's kappa index of 1.000). Teledermatology is a reliable tool for the follow-up of AK treated with DL-PDT, demonstrating results equivalent to in-person evaluation. This supports its implementation in clinical practice, particularly in cases where in-person access is limited.
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Influence of serum vitamin D level in the response of actinic keratosis to ingenol mebutate. 血清维生素D水平对光化性角化病对ingenol mebutate反应的影响。
Vitamin D (VD) serum levels, and keratinocytic basal expression of vitamin D receptor (VDR) before treatment of actinic keratoses (AK) have been previously reported as possible biomarkers of the response of AK to treatments. We intended to evaluate the association between these and other serum and immunohistochemical parameters with the response of AK to treatment with topical ingenol mebutate (IM). Twenty-five patients with AK on the head were treated with topical IM 0.015% gel once daily for 3 days. Biopsies were taken at baseline and 6 weeks after treatment. Immunohistochemical staining was performed for VDR, P53, Ki67, Aurora B, Survivin and β-catenin. Basal serum 25(OH)D levels were determined. IM was more effective for KIN I and II AKs than in KIN III, and histological responders showed significantly higher serum VD levels (30.278 [SD 8.839] ng/mL) than nonresponders (21.14 [SD 7.079] ng/mL, p = 0.023). In addition, mean basal expression of VDR (45.63 [SD 16.105] %) increased significantly (57.92 [SD 14.738] %, p = 0.003) after treatment with IM. A significant decrease after treatment in the expression of several markers of aggressiveness and progression to squamous cell carcinoma, namely P53, Ki-67, aurora B kinase and survivin, was also observed. Our results support a relationship between VD status and the response of AK to treatment with topical IM, suggesting that its previous correction to proper serum levels in VD-deficient patients could improve the response of AK to the treatment.
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Clinicopathologic Features and Outcomes of Actinic Keratosis and Skin Cancer After Hematopoietic Stem Cell Transplantation. 造血干细胞移植后光化性角化病和皮肤癌的临床病理特征及结局。
Patients undergoing hematopoietic stem cell transplantation (HSCT) are at an increased risk of secondary skin neoplasms. However, detailed clinicopathological and therapeutic descriptions are limited. We conducted a prospective, observational, single-center study including HSCT recipients. Patients with actinic keratosis or skin/mucosal malignancies were evaluated by expert dermatologists, with a histological review. Management followed standard protocols, and patients were stratified according to the National Comprehensive Cancer Network (NCCN) guidelines. Of the 2042 HSCT recipients, 96 (4%) developed any actinic keratosis or skin cancer, with a median latency period of approximately three years. The most common lesions were basal cell carcinoma (BCC, 35%), actinic keratosis (30%), and squamous cell carcinoma (SCC, 22%), followed by melanoma (9%). The lesions predominantly appeared on the face and scalp. Almost 20% of invasive SCCs or BCCs exhibited high-risk histopathological features, most commonly micronodular BCC and deep invasion in SCC. Surgical excision was the primary treatment; however, a high percentage of positive margins was found, especially in SCCs. At follow-up, 47% of patients developed subsequent lesions, typically of the same histological subtype or actinic keratosis, with a median time to recurrence of 9.5 months. One patient died from metastatic SCC of the lip. This study provides the most detailed clinicopathological description of post-HSCT cutaneous lesions to date. While most tumors were non-aggressive, the high prevalence of high-risk features and recurrence highlights the need for dermatological surveillance. Nearly half of patients develop new lesions within months of the first diagnosis, so regular follow-up is warranted.
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Low-level light-assisted photodynamic therapy using a wearable cap-like device for the treatment of actinic keratosis of the scalp. 使用可穿戴帽状装置进行低水平光辅助光动力疗法治疗头皮光化性角化病。
Daylight photodynamic therapy (dlPDT) is a painless and increasingly cost-effective treatment for actinic keratosis (AK). New protocols avoid incubation, minimizing pain and adverse events. However, it is time-consuming and dependent on specific weather conditions. In patients with AK of the scalp, we evaluated the efficacy of indoor photodynamic therapy (PDT) using a wearable low-level light therapy (LLLT) device, without pre-incubation with a photosensitizing agent. In this pilot study, 27 patients with thin and moderately thick AK (Olsen Grades I-II) underwent a single 15-minute session of LLLT using a wearable cap-like device immediately after application of methyl-aminolevulinate (MAL) cream, with no prior preparation of the affected area. Treatment efficacy was quantified by measuring the reduction in AK lesion number and the AK quality of life (AKQoL) score. All AK lesions were mapped at baseline for follow-up 2 months later. Paired pre/post scalp biopsies from 5 patients were analysed using histological and immunohistochemical techniques (p53, p27, cyclin D1, p63, and Ki67 expression). Data were analysed using the Wilcoxon signed-rank test. In all patients we observed a global reduction in the number of AK lesions (71%; p < 0.0001) and AKQoL score (from 5.6 to 4.4; p = 0.034) 2 months after treatment. Histology and immunohistochemistry of skin biopsies from 5 patients also revealed marked improvements after LLLT. No patients reported any pain during treatment. PDT using LLLT is a rapid, painless, and efficacious modality for the treatment of AK.
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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. 光化性角化病和皮肤鳞状细胞癌S3指南——简版，第1部分：诊断、光化性角化病的干预措施、护理结构和护理质量指标。
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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Daylight-mediated photodynamic therapy for actinic damage in Latin America: consensus recommendations. 拉丁美洲日光介导光动力疗法治疗光化性损伤：共识建议。
Although conventional photodynamic therapy (c-PDT) using methyl aminolevulinate cream (MAL) is effective for the treatment of grade I-II facial and scalp actinic keratosis (AK), it is associated with treatment-related pain for some patients. Daylight-mediated PDT (DL-PDT) has shown similar efficacy to c-PDT, was nearly painless, and was well tolerated. Overall, DL-PDT effectively treats AK and offers a simpler and better tolerated treatment option than c-PDT. This consensus panel provided recommendations on the use of DL-PDT in Latin America (LATAM) for the treatment of actinic damage associated with few or multiple AKs. The panel was comprised of eight dermatologists from different LATAM countries who have experience using PDT for the treatment of actinic damage. The panel reviewed the relevant literature and provided personal expertise with regard to using DL-PDT for the treatment of photodamage with or without AK. The recommendations formulated by the expert panel provide evidence-based guidelines on all aspects of DL-PDT for the treatment of actinic damage associated with AK in different regions of LATAM. These recommendations provide guidance for dermatologists to ensure maintenance of efficacy and safety of DL-PDT when treating actinic damage, associated with few or multiple AKs in sun-exposed skin.
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Improving the efficacy of photodynamic therapy for actinic keratosis: A comprehensive review of pharmacological pretreatment strategies. 提高光动力疗法治疗光化性角化病的疗效：药理学预处理策略的全面综述
Photodynamic therapy (PDT) is approved for treatment of actinic keratoses (AKs) and field-cancerisation. Pretreatment with pharmacological compounds holds potential to improve PDT efficacy, through direct interaction with PpIX formation or through an independent response, both of which may improve PDT treatment. To present the currently available clinical evidence of pharmacological pretreatments prior to PDT and to associate potential clinical benefits with the pharmacological mechanisms of action of the individual compounds. A comprehensive search on the Embase, MEDLINE, and Web of Science databases was performed. In total, 16 studies investigated 6 pretreatment compounds: 5-fluorouracil (5-FU), diclofenac, retinoids, salicylic acid, urea, and vitamin D. Two of these, 5-FU and vitamin D, robustly increased the efficacy of PDT across multiple studies, illustrated by mean increases in clearance rates of 21.88% and 12.4%, respectively. Regarding their mechanisms, 5-FU and vitamin D both increased PpIX accumulation, while 5-FU also induced a separate anticarcinogenic response. Pretreatment with diclofenac for four weeks improved the clearance rate in one study (24.9%), administration of retinoids had a significant effect in one of two studies (16.25%), while salicylic acid and urea did not lead to improved PDT efficacy. Diclofenac and retinoids demonstrated independent cytotoxic responses, whereas salicylic acid and urea acted as penetration enhancers to increase PpIX formation. 5-FU and vitamin D are well-tested, promising candidates for pharmacological pretreatment prior to PDT. Both compounds affect the haem biosynthesis, providing a target for potential pretreatment candidates. Photodynamic Therapy, Actinic Keratosis,Pre-tretment,Review,enhancement.