Review Article

Actinic Keratosis Clinical Practice Guidelines: An Appraisal of Quality

Table 3

Samples of recommendations from the three CPG with the highest overall scores.

GuidelineSamples of CPG recommendations

CCA/ACN [11](i) In many cases solar keratosis [AK] regresses spontaneously and uncommonly; it evolves into squamous cell carcinoma
(ii) The chances that an individual solar keratosis [AK] will develop into SCC are extremely small; however when one encounters SCC, the chance that it has arisen in association with solar keratosis is very high
(iii) Thickening and tenderness on lateral palpation are signs that a solar keratosis may have developed into invasive squamous cell carcinoma

de Berker et al. [12](i) Studies indicate a high spontaneous regression rate in the order of 15–25% for AKs over a 1-year period and a low rate of malignant transformation, less than one in 1,000 per annum.
(ii) No therapy or emollient is a reasonable option for mild AKs
(iii) Sun block applied twice daily for 7 months may protect against development of AKs
(iv) 5-Fluorouracil cream used twice daily for 6 weeks is effective for up to 12 months in clearance of the majority of AKs; due to side-effects of soreness, less aggressive regimens are often used, which may be effective but have not been fully evaluated
(v) Cryosurgery is effective for up to 75% of lesions in trials comparing it with photodynamic therapy; it may be particularly superior for thicker lesions but may leave scars

Stockfleth and Kerl (2006) [13] (i) Cryotherapy is often used and controlled studies are missing. Complete responses differ from 75% to 98%; the recurrence rates of AKs have been estimated from 1.2% to 12% within a 1-year follow-up period
(ii) The clinical experience in AK patients receiving MAL-PDT shows complete response rate of 70–78% after a single treatment session and 90% after two treatment sessions one week apart; negative effects of PDT are local pain, risk of photosensitivity (mainly for ALA), and time delay between application of cream and treatment. Photodynamic therapy in comparison to cryotherapy shows significantly better cosmetic results