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      Randomized Trial of Four Treatment Approaches for Actinic Keratosis

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          Actinic keratoses: Natural history and risk of malignant transformation in the Veterans Affairs Topical Tretinoin Chemoprevention Trial.

          Actinic keratoses (AKs) are established as direct precursors of squamous cell carcinoma (SCC), but there is significant controversy regarding the rate at which AKs progress to SCC. The authors of this report studied a high-risk population to estimate the risk of progression of AK to SCC and to basal cell carcinoma (BCC) and the risk of spontaneous regression of untreated AKs. Data were obtained from participants in the Department of Veterans Affairs Topical Tretinoin Chemoprevention Trial. Participants were examined every 6 months for up to 6 years. At each examination, the locations on the face and ears of clinically diagnosed AKs and lesions scheduled for biopsy were marked, and high-resolution digital photographs were taken. These photographs were used later to map and track the presence, absence, or biopsy of each AK across visits. In total, 7784 AKs were identified on the face and ears of 169 participants. The risk of progression of AK to primary SCC (invasive or in situ) was 0.60% at 1 year and 2.57% at 4 years. Approximately 65% of all primary SCCs and 36% of all primary BCCs diagnosed in the study cohort arose in lesions that previously were diagnosed clinically as AKs. The majority of AKs (55%) that were followed clinically were not present at the 1-year follow-up, and the majority (70%) were not present at the 5-year follow-up. In the current study, the authors quantified the malignant potential of clinically diagnosed AKs for both SCC and BCC, although many did not persist, and the results suggested that AKs may play a greater role in the overall burden of keratinocyte carcinomas than previously documented.
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            Evidence- and consensus-based (S3) Guidelines for the Treatment of Actinic Keratosis - International League of Dermatological Societies in cooperation with the European Dermatology Forum - Short version.

            Actinic keratosis (AK) is a frequent health condition attributable to chronic exposure to ultraviolet radiation. Several treatment options are available and evidence based guidelines are missing.
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              Prevalence of actinic keratosis and its risk factors in the general population: the Rotterdam Study.

              Limited data are available on the prevalence and risk factors of actinic keratoses (AKs). Within the Rotterdam Study, full-body skin examinations were performed among participants aged 45 years or older to estimate the age- and sex-standardized prevalence of AK and its associated risk factors. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for associations between risk factors and the presence of 1-3, 4-9, and ≥ 10 AKs. Of the 2,061 inspected cohort members (mean age 72 years), 21% had 1-3, 9% had 4-9, and 8% had ≥ 10 AKs. AK prevalence was 49% (95% CI: 46-52%) for men and 28% (26-31%) for women. Male gender, older age, light pigmentation status, severe baldness, skin wrinkling, and high tendency for sunburn were significantly associated with extensive actinic damage (≥ 10 AKs) in the multivariate analyses. Especially bald males were at an increased risk of severe actinic skin damage (adjusted OR=7.0 (3.8-13.1)). The prevalence of AK is very high, especially among elderly bald males. The prevention and management of AK is a true challenge for patients, physicians, and health-care policymakers.
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                Author and article information

                Journal
                New England Journal of Medicine
                N Engl J Med
                Massachusetts Medical Society
                0028-4793
                1533-4406
                March 07 2019
                March 07 2019
                : 380
                : 10
                : 935-946
                Affiliations
                [1 ]From the Departments of Dermatology (M.H.E.J., J.P.H.M.K., N.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and Clinical Epidemiology and Medical Technology Assessment (B.A.B.E.), Maastricht University Medical Center, and the GROW School for Oncology and Developmental Biology (M.H.E.J., J.P.H.M.K., A.H.M.M.A., P.M.S., N.W.J.K.-S., K.M.) and the Department of Epidemiology (P.J.N.), Maastricht University, Maastricht, the Department of Dermatology, Zuyderland Medical Center, Heerlen (J.P.H.M.K., P.J.F.Q.), the...
                Article
                10.1056/NEJMoa1811850
                30855743
                1936e249-2de2-4048-b606-3451dc053b40
                © 2019

                http://www.nejmgroup.org/legal/terms-of-use.htm

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