Management Pearls on the Treatment of Actinic Keratoses and Field Cancerization
Management Pearls on the Treatment of Actinic Keratoses and Field Cancerization
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DOI：
10.1007/s13555-020-00425-4
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发表时间：
2020-07-17
影响因子：
3.4
通讯作者：
Luis Lopez-Estebaranz, Jose
中科院分区：
文献类型：
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作者：
Piquero-Casals, Jaime;Morgado-Carrasco, Daniel;Luis Lopez-Estebaranz, Jose
野癌化 (FC) 是一种慢性疾病，涉及大片曝光表面上的多种临床和亚临床光化性角化病 (AK)，并伴有多灶性不典型增生和癌前病变区域。必须对患者和治疗进行适当的监测和管理，以避免疾病恶化和进展。光化性角化病的治疗包括针对病变的治疗，例如冷冻疗法和现场定向治疗。现场定向治疗可能有可能解决亚临床损伤、降低 AK 复发率并可能降低鳞状细胞癌发展的风险。多项研究证明了现场定向治疗（包括 5-氟尿嘧啶、光动力疗法、咪喹莫特、三氯乙酸化学剥脱术和双氯芬酸凝胶）对多种 AK 和 FC 的疗效。治疗的选择应基于多种因素，例如疗效、耐受性、患者风险状况、费用和美容效果。 AK 的管理不仅包括治疗，还包括预防。医疗器械，例如含有脂质体封装的 DNA 修复酶的防晒霜，可以修复与慢性紫外线辐射相关的 DNA 损伤，并减少新的 AK 损伤的数量。在这里，我们提供有关 AK 和 FC 治疗（单一疗法或联合疗法）的治疗要点和专家意见，总体目标是实现更好、更快和耐受性良好的临床反应。
Field cancerization (FC) is a chronic disease involving multiple clinical and subclinical actinic keratoses (AK) on large photo-exposed surfaces with multifocal areas of dysplasia and precancerous changes. Patients and treatment must be properly monitored and managed to avoid aggravation and progression of the disease. Management of actinic keratoses includes lesion-directed treatments, such as cryotherapy and field-directed therapies. Field-directed therapies may have the potential to address subclinical damage, reduce AK recurrence rates and potentially reduce the risk of squamous cell carcinoma development. Multiple studies have demonstrated the efficacy of field-directed treatments, including 5-fluorouracil, photodynamic therapy, imiquimod, chemical exfoliation with trichloroacetic acid and diclofenac gel, for multiple AK and FC. The choice of therapy should be based on multiple factors, such as efficacy, tolerability, patient risk profile, costs and cosmetic results. Management of AK includes not only treatment but also prevention. Medical devices, such as sunscreens containing liposome-encapsulated DNA repair enzymes, can repair DNA damage associated with chronic UV radiation and reduce the number of new AK lesions. Here we provide therapeutic pearls and expert opinions on the treatment of AK and FC (as monotherapy or in combination) with the overall aim to achieve better, faster, and well-tolerated clinical responses.