German S3 guideline "actinic keratosis and cutaneous squamous cell carcinoma" – long version of the update 2023

Actinic keratosis (AK) are common lesions in light-skinned individuals that can potentially progress to cutaneous squamous cell carcinoma (cSCC). Both conditions may be associated with significant morbidity and constitute a major disease burden, especially among the elderly. To establish an evidence-based framework for clinical decision making, the guideline “actinic keratosis and cutaneous squamous cell carcinoma” was updated and expanded by the topics cutanepus squamous cell carcinoma in situ (Bowen’s disease) and actinic cheilitis. This guideline was developed at the highest evidence level (S3) and is aimed at dermatologists, general practitioners, ear nose and throat specialists, surgeons, oncologists, radiologists and radiation oncologists in hospitals and office-based settings, as well as other medical specialties, policy makers and insurance funds involved in the diagnosis and treatment of patients with AK and cSCC

Phase 3 trials of ixekizumab in moderate-to-severe plaque psoriasis

BACKGROUND Two phase 3 trials (UNCOVER-2 and UNCOVER-3) showed that at 12 weeks of treatment, ixekizumab, a monoclonal antibody against interleukin-17A, was superior to placebo and etanercept in the treatment of moderate-to-severe psoriasis. We report the 60-week data from the UNCOVER-2 and UNCOVER-3 trials, as well as 12-week and 60-week data from a third phase 3 trial, UNCOVER-1. METHODS We randomly assigned 1296 patients in the UNCOVER-1 trial, 1224 patients in the UNCOVER-2 trial, and 1346 patients in the UNCOVER-3 trial to receive subcutaneous injections of placebo (placebo group), 80 mg of ixekizumab every 2 weeks after a starting dose of 160 mg (2-wk dosing group), or 80 mg of ixekizumab every 4 weeks after a starting dose of 160 mg (4-wk dosing group). Additional cohorts in the UNCOVER-2 and UNCOVER-3 trials were randomly assigned to receive 50 mg of etanercept twice weekly. At week 12 in the UNCOVER-3 trial, the patients entered a long-term extension period during which they received 80 mg of ixekizumab every 4 weeks through week 60; at week 12 in the UNCOVER-1 and UNCOVER-2 trials, the patients who had a response to ixekizumab (defined as a static Physicians Global Assessment [sPGA] score of 0 [clear] or 1 [minimal psoriasis]) were randomly reassigned to receive placebo, 80 mg of ixekizumab every 4 weeks, or 80 mg of ixekizumab every 12 weeks through week 60. Coprimary end points were the percentage of patients who had a score on the sPGA of 0 or 1 and a 75% or greater reduction from baseline in Psoriasis Area and Severity Index (PASI 75) at week 12. RESULTS In the UNCOVER-1 trial, at week 12, the patients had better responses to ixekizumab than to placebo; in the 2-wk dosing group, 81.8% had an sPGA score of 0 or 1 and 89.1% had a PASI 75 response; in the 4-wk dosing group, the respective rates were 76.4% and 82.6%; and in the placebo group, the rates were 3.2% and 3.9% (P<0.001 for all comparisons of ixekizumab with placebo). In the UNCOVER-1 and UNCOVER-2 trials, among the patients who were randomly reassigned at week 12 to receive 80 mg of ixekizumab every 4 weeks, 80 mg of ixekizumab every 12 weeks, or placebo, an sPGA score of 0 or 1 was maintained by 73.8%, 39.0%, and 7.0% of the patients, respectively. Patients in the UNCOVER-3 trial received continuous treatment of ixekizumab from weeks 0 through 60, and at week 60, at least 73% had an sPGA score of 0 or 1 and at least 80% had a PASI 75 response. Adverse events reported during ixekizumab use included neutropenia, candidal infections, and inflammatory bowel disease. CONCLUSIONS In three phase 3 trials involving patients with psoriasis, ixekizumab was effective through 60 weeks of treatment. As with any treatment, the benefits need to be weighed against the risks of adverse events. The efficacy and safety of ixekizumab beyond 60 weeks of treatment are not yet known

Daylight PDT with MAL - current data and practical recommendations of an expert panel

Die photodynamische Therapie (PDT) gehört zu den Standardverfahren in der Therapie aktinischer Keratosen (AK). Bei der Tageslicht-PDT (Daylight PDT, DL-PDT) mit MAL-Creme handelt es sich um eine neuere Entwicklung, bei der anstelle eines Belichtungssystems das Tageslicht zur Aktivierung des Photosensibilisators genutzt wird. Der vorliegende Review fasst die aktuelle Studienlage basierend auf einer selektiven Literaturrecherche zusammen, fokussiert auf praktische Aspekte in der Durchführung und reflektiert insbesondere auch die Expertenerfahrung der Autoren mit der DL-PDT. Studiendaten zeigen, dass die DL-PDT der konventionellen PDT in ihrer Wirksamkeit nicht unterlegen ist. Sie ist jedoch signifikant besser verträglich, da sie zu deutlich weniger Schmerzen während der Therapie führt. Sie kann in Mitteleuropa von März bis Oktober sowohl an bewölkten als auch an sonnigen Tagen durchgeführt werden. Hierbei ist auf UV-Schutz auch der nicht behandelten Körperareale zu achten. Die Außentemperatur sollte 10°C nicht unterschreiten. An heißen Tagen sollte ein Aufenthalt im Schatten, soweit erforderlich, eingeplant werden. Die DL-PDT mit MAL ist u. a. für Patienten mit Feldkanzerisierung und/oder negativer Schmerzerfahrung bei der cPDT geeignet und stellt eine sinnvolle Ergänzung der aktuellen Therapiemöglichkeiten dar

S2k Guidelines for cutaneous basal cell carcinoma - Part 2: Treatment, prevention and follow-up

Basal cell carcinoma (BCC) is the most common malignant tumor among fair‐skinned individuals, and its incidence had been steadily rising in the past decades. In order to maintain the highest quality of patient care possible, the German S2k guidelines were updated following a systematic literature search and with the participation of all professional societies and associations involved in the management of the disease. Part 2 addresses issues such as proper risk stratification, the various therapeutic approaches, and prevention as well as follow‐up of patients with basal cell carcinoma. Das Basalzellkarzinom (BZK) ist der häufigste maligne Tumor der hellhäutigen Bevölkerung mit jährlich steigender Inzidenz. Eine Aktualisierung der S2k‐Leitlinie unter Beteiligung aller mit dem Krankheitsbild vertrauten Fachgesellschaften sowie vorangegangener Literaturrecherche ist für die Qualität der Versorgung der betroffenen Patienten von essentieller Bedeutung. Im vorliegenden Teil 2 wird zunächst eine Risikostratifizierung aufgezeigt, bevor die verschiedenen Therapieoptionen diskutiert werden. Zudem werden Prävention und Nachsorge der Erkrankung behandelt

S2k Guidelines for Cutaneous Basal Cell Carcinoma - Part 1: Epidemiology, Genetics and Diagnosis

Basal cell carcinoma is the most common malignant tumor among fair‐skinned individuals, and its incidence has been rising steadily in the past decades. In order to maintain the highest quality of patient care possible, the German S2k guidelines were updated following a systematic literature search and with the participation of all professional societies and associations involved in the management of the disease. Part 1 highlights new developments in genetics in particular as well as aspects regarding epidemiology, diagnosis, and histology. Das Basalzellkarzinom ist der häufigste maligne Tumor der hellhäutigen Bevölkerung mit jährlich steigender Inzidenz. Eine Aktualisierung der S2k‐Leitlinie unter Beteiligung aller mit dem Krankheitsbild vertrauten Fachgesellschaften sowie vorangegangener Literaturrecherche ist für die Qualität der Versorgung der betroffenen Patienten von essentieller Bedeutung. Im vorliegenden Teil 1 wird neben Epidemiologie insbesondere auf die neuen Erkenntnisse der Genetik eingegangen sowie Diagnostik und Histologie diskutiert