Search

Abstract: Actinic keratoses (AK) arise on sun‐exposed regions of the skin. If left untreated, AK may progress to invasive squamous cell carcinoma (SCC), although the rate of progression is low. A practical treatment algorithm for the treatment of AK in standard situations has been published by the AKTeam™ expert panel. However, management of particular situations of AK with increasing/higher carcinoma risk or AK progressing into carcinomas with increased aggressiveness due to their anatomical location (risky areas), or in patients with an increased risk of SCC requires further discussion. These include AK on the dorsal hands, forearms, legs, periorbital region, eyelids, ears, or lips, and organ transplant recipients, patients undergoing treatment with carcinogenic agents and patients with chronic lymphocytic leukaemia. The main objective was to propose therapeutic strategies for the treatment of AK located in risky areas and in patients with more invasive/aggressive lesions and a higher risk of progression to SCC. A systematic review of the literature was initially performed, and results were discussed by the experts to propose best management practices in specific situations. Finally, adapted management strategies for AK occurring in risky areas and in high‐risk patients are presented, taking into account the experts’ own clinical experience and current guidelines. In most of these ‘at‐risk’ situations, patients can be treated according to the AKTeam™ treatment algorithm. Difficult‐to‐treat lesions should be treated more aggressively due to their higher risk of transformation. For patients with skin that is highly susceptible to actinic damage, monitoring and sun protection strategies are mandatory, and patients should undergo more regular follow‐up. Further assessment of newer therapies in clinical trials is necessary to determine optimal treatment conditions. This expert consensus provides guidance for the management of AK in risky body sites and in patients with an increasing/higher risk for SCCs. [ABSTRACT FROM AUTHOR]

Background Skin cancer surgery is usually performed on the face, and more specifically on and around the midfacial apertures. Each defect generated by the exeresis of a face tumor can be repaired by various advancement, rotation or transposition flaps techniques. Therefore the choice of the closure axis of a defect and its cicatricial and orificial consequences is decisive. Results The closure of a defect is usually made by symmetrically suturing its edges, across the incision axis according to the rule of halves. However, the closure axis of a defect is intentional and characterized by the subcutaneous suture axis which determines the induced tension orientation, and thus the possible displacement of the aperture free margins. The horizontal stretching principle guarantees the lack of impact on the 3 major apertures of the midfacial frame: eye, nostril and mouth. Conclusions This biomechanical concept is decisive to repair midfacial defect with functional and aesthetic results. It also provides objective arguments for the reparative techniques prioritization and the ability to codify those to be recommended as first-line treatment in the surgical management of the face cutaneous tumours. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding a patient with recurring human papillomavirus (HPV) associated squamous cell cancer on a psoriatic plaque.

Background: Actinic keratoses (AK) are common photo-induced cutaneous lesions that may progress to invasive squamous-cell carcinoma and serve as a risk marker for skin cancer. Although numerous studies present the various therapeutic options for AK, publications that can be used to pragmatically guide dermatologists in their daily practice are limited. National and international guidelines have been published, however, they are based on clinical trials with highly selected patient populations and do not always capture the range of patients seen in everyday practice., Objective: The objective of this expert panel of French dermatologists was to present an analysis of AK geared towards everyday practice, to express an informed opinion about most recent treatments, and to propose a treatment algorithm for AK for daily practice in France., Methods: Over a 12 month period, six expert dermatologists in the field of AK (AKTeam(TM) expert panel) met regularly to formulate an opinion about treatment in everyday practice compared with the analysis of the literature and guidelines published since 1990., Results: Definitions, terminology, diagnosis and risk factors were summarized. Data from the literature and current practices related to the initial evaluation, indications for biopsy, therapeutic indications, therapeutic options and effectiveness, monitoring and prevention were discussed. A pragmatic treatment algorithm was formalized according to current data available. This practical algorithm distinguishes between different clinical situations depending on the number of AK, their hyperkeratotic or suspicious nature, and includes cryotherapy, curettage-electrocoagulation, 5% 5-fluorouracil, 3% diclofenac sodium, 5% imiquimod, 150 and 500 μg/g ingenol mebutate, lasers, photodynamic therapy and surgery., Conclusion: This up-to-date expert opinions about AK and its treatment provide a management strategy and practical treatment algorithm for AK for French dermatologists to use., (© 2014 European Academy of Dermatology and Venereology.)