GUIDELINES IN DERMATOLOGY

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ACTINIC KERATOSIS, BOWEN AND SQUAMOUS CELL CARCINOMA

Pelin Ertop Doğan1
Bengü Nisa Akay2

1Bülent Ecevit University, Faculty of Medicine, Department of Dermatology, Zonguldak, Türkiye
2Ankara University, Faculty of Medicine, Department of Dermatology, Ankara, Türkiye

Ertop Doğan P, Akay BN. Actinic Keratosis, Bowen and Squamous Cell Carcinoma. In: Kutlubay Z, editor. Guidelines in Dermatology. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.293-300.

ABSTRACT

Cutaneous squamous cell carcinoma (cSCC) is the second most common non-melanoma skin cancer, following basal cell carcinoma. It can manifest either as the in situ form (Bowen’s disease) or as the invasive form. Actinic keratosis (AK) represents a focal abnormal keratinocyte proliferation and differentiation that holds the potential to progress to SCC. Cutaneous field cancerization, prevalent in areas exposed to chronic ultraviolet radiation, poses an additional concern. The increasing incidence of SCC, linked to an aging population and increased awareness of skin cancer, highlights the importance of follow-up and treatment for keratinocyte cancers. Understanding the concept of field cancerization also plays a pivotal role in the effective management of these conditions. In the management of AK and SCCs, it is essential to consider the clinical features of the patient, comorbidities, lesion characteristics and the presence of field carcinogenesis. The treatment of AK can be performed in two ways: lesion-directed treatments and field treatments. Lesion-directed treatments encompass a range of techniques, including cryotherapy, laser treatments, surgical excision and curettage. Topically applied 5-fluorouracil, diclofenac, imiquimod, chemical peels and photodynamic therapy (PDT) are the preferred treatment options for field cancerisation. Surgical excision, ablative procedures such as cryotherapy or laser therapy, topical agents and PDT may be selected for the treatment of the in situ form, depending on the patient and the characteristics of the lesion. The primary goal in SCC is to completely remove the tumour while preserving functional and aesthetic results. Depending on the patient and lesion characteristics, surgical excision, radiotherapy, lymph node excision or systemic treatments such as immunotherapy and chemotherapy may be preferred. SCC is classified as common primary SCC, locally advanced and metastatic. The classification of primary SCC as low, intermediate, or high risk is determined by the likelihood of recurrence, and the surgical excision margin is subsequently selected on this basis. Radiotherapy is the preferred treatment option when surgical excision is not feasible or when re-excision is not possible in cases with positive margins following surgical excision. Systemic treatments comprise immunotherapy, epidermal growth factor receptor (EGFR) inhibitors and chemotherapy. These are employed in the treatment of locally advanced and metastatic SCC. The management of AK and SCCs presents a multitude of treatment options, each of which necessitates a meticulous multidisciplinary approach. It is also of great importance to convey to patients the necessity of sun protection in a multidimensional manner. The following article reviews the various treatment options in accordance with the relevant clinical guidelines.

Keywords: Actinic keratosis; Squamous cell carcinoma; Bowen’s disease; Therapy; Guideline

Referanslar

  1. Que SKT, Zwald FO, Schmults CD. Cutaneous squamous cell carcinoma: Incidence, risk factors, diagnosis, and staging. J Am Acad Dermatol. 2018;78(2):237-47. [Crossref]  [PubMed]
  2. Fania L, Didona D, Di Pietro FR, Verkhovskaia S, Morese R, Paolino G, et al. Cutaneous Squamous Cell Carcinoma: From Pathophysiology to Novel Therapeutic Approaches. Biomedicines. 2021;9(2). [Crossref]  [PubMed]  [PMC]
  3. Gupta G, Madan V, Lear JT. Squamous Cell Carcinoma and its Precursors. In: Griffiths CEM, Barker J, Bleiker TO, Chalmers R, Creamer D, editors. Rook's Textbook of Dermatology. Ninth Edition ed: Wiley; 2016. [Crossref]
  4. Willenbrink TJ, Ruiz ES, Cornejo CM, Schmults CD, Arron ST, Jambusaria-Pahlajani A. Field cancerization: Definition, epidemiology, risk factors, and outcomes. J Am Acad Dermatol. 2020;83(3):709-17. [Crossref]  [PubMed]
  5. Heppt MV, Leiter U, Steeb T, Amaral T, Bauer A, Becker JC, et al. 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(3):275-94. [Crossref]  [PubMed]
  6. Leiter U, Heppt MV, Steeb T, Amaral T, Bauer A, Becker JC, et al. S3 guideline for actinic keratosis and cutaneous squamous cell carcinoma (cSCC) short version, part 2: epidemiology, surgical and systemic treatment of cSCC, follow-up, prevention and occupational disease. J Dtsch Dermatol Ges. 2020;18(4):400-13. [Crossref]  [PubMed]
  7. Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, Bataille V, Bastholt L, et al. European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 2. Treatment. Eur J Cancer. 2020;128:83-102. [Crossref]  [PubMed]
  8. Work G, Invited R, Kim JYS, Kozlow JH, Mittal B, Moyer J, et al. Guidelines of care for the management of cutaneous squamous cell carcinoma. J Am Acad Dermatol. 2018;78(3):560-78. [Crossref]  [PubMed]  [PMC]
  9. Ronsch H, Bauer A. The Preventive Value of Sun Protection. Curr Probl Dermatol. 2021;55:316-28. [Crossref]  [PubMed]
  10. Eisen DB, Asgari MM, Bennett DD, Connolly SM, Dellavalle RP, Freeman EE, et al. Guidelines of care for the management of actinic keratosis. J Am Acad Dermatol. 2021;85(4):e209-e33. [Crossref]  [PubMed]
  11. Werner RN, Sammain A, Erdmann R, Hartmann V, Stockfleth E, Nast A. The natural history of actinic keratosis: a systematic review. Br J Dermatol. 2013;169(3):502-18. [Crossref]  [PubMed]
  12. Stockfleth E. The importance of treating the field in actinic keratosis. J Eur Acad Dermatol Venereol. 2017;31 Suppl 2:8-11. [Crossref]  [PubMed]
  13. Dianzani C, Conforti C, Giuffrida R, Corneli P, di Meo N, Farinazzo E, et al. Current therapies for actinic keratosis. Int J Dermatol. 2020;59(6):677-84. [Crossref]  [PubMed]
  14. Arcuri D, Ramchatesingh B, Lagace F, Iannattone L, Netchiporouk E, Lefrancois P, et al. Pharmacological Agents Used in the Prevention and Treatment of Actinic Keratosis: A Review. Int J Mol Sci. 2023;24(5). [Crossref]  [PubMed]  [PMC]
  15. Worley B, Harikumar V, Reynolds K, Dirr MA, Christensen RE, Anvery N, et al. Treatment of actinic keratosis: a systematic review. Arch Dermatol Res. 2023;315(5):1099-108. [PubMed]
  16. Wu Y, Tang N, Cai L, Li Q. Relative efficacy of 5-fluorouracil compared with other treatments among patients with actinic keratosis: A network meta-analysis. Dermatol Ther. 2019;32(3):e12822. [Crossref]  [PubMed]
  17. Miller AC, Adjei S, Temiz LA, Tyring SK. Tirbanibulin for the Treatment of Actinic Keratosis: A Review. Skin Therapy Lett. 2022;27(4):4-7. [PubMed]
  18. Arisi M, Guasco Pisani E, Calzavara-Pinton P, Zane C. Cryotherapy for Actinic Keratosis: Basic Principles and Literature Review. Clin Cosmet Investig Dermatol. 2022;15:357-65. [Crossref]  [PubMed]  [PMC]
  19. Heppt MV, Steeb T, Ruzicka T, Berking C. Cryosurgery combined with topical interventions for actinic keratosis: a systematic review and meta-analysis. Br J Dermatol. 2019;180(4):740-8. [Crossref]  [PubMed]
  20. Bakirtzi K, Papadimitriou I, Vakirlis E, Lallas A, Sotiriou E. Photodynamic Therapy for Field Cancerization in the Skin: Where Do We Stand? Dermatol Pract Concept. 2023;13(4). [Crossref]  [PubMed]  [PMC]
  21. Sharma A, Birnie AJ, Bordea C, Cheung ST, Mann J, Morton CA, et al. British Association of Dermatologists guidelines for the management of people with cutaneous squamous cell carcinoma in situ (Bowen disease) 2022. Br J Dermatol. 2023;188(2):186-94. [Crossref]  [PubMed]
  22. Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, van Akkooi A, Bataille V, et al. European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma: Part 2. Treatment-Update 2023. Eur J Cancer. 2023;193:113252. [Crossref]  [PubMed]
  23. Schmults CD, Blitzblau R, Aasi SZ, et.al. NCCN (National Comprehensive Cancer Network) Guidelines Version 1.2024 Squamous Cell Skin Cancer. 2024. [Link]
  24. Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, van Akkooi A, Bataille V, et al. European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma. Part 1: Diagnostics and prevention-Update 2023. Eur J Cancer. 2023;193:113251. [Crossref]  [PubMed]
  25. Keohane SG, Botting J, Budny PG, Dolan OM, Fife K, Harwood CA, et al. British Association of Dermatologists guidelines for the management of people with cutaneous squamous cell carcinoma 2020. Br J Dermatol. 2021;184(3):401-14. [Crossref]  [PubMed]
  26. Dessinioti C, Stratigos AJ. Overview of guideline recommendations for the management of high-risk and advanced cutaneous squamous cell carcinoma. J Eur Acad Dermatol Venereol. 2022;36 Suppl 1:11-8. [Crossref]  [PubMed]