Background: Actinic keratoses (AKs) is one of the most common dermatological diagnoses worldwide, especially among the elderly, fair-skinned, and immunocompromised patients. AK are scaly, pink to reddish-brown scaly lesions on erythematous base appearing as single to multiple elements on sun-exposed areas. They are considered as an early in situ squamous cell carcinoma (SCC), with a risk of progression to invasive SCC (iSCC) estimated to range between 0.025% and 16% per year. The diagnosis is based on clinical and dermoscopic evaluation. Other non-invasive techniques such as reflectance confocal microscopy (RCM), optical coherence tomography (OCT) and line-field confocal optical coherence tomography (LC-OCT) represent further tools for differential diagnosis and characterization. Several clinical, dermoscopic ad histological classification systems have been proposed for grading AK lesions. Due to their potential risk of progression to iSCC, all AK should be treated, and clinical follow-up is recommended.
Observation: Among available treatments, it is possible to distinguish lesion-directed therapies (cryotherapy, laser therapy and surgery when a progression to iSCC is suspected) and field-directed therapies (5-fluorouracil, diclofenac, imiquimod and photodynamic therapy). Recently, Tirbanibulin, proved its efficacy in the treatment of AK in two phase III clinical trials; it inhibits Src kinase signaling and tubulin polymerisation, stimulating arrest in the cell cycle in just 5 consecutive days of application.
We evaluated efficacy, safety and adherence to therapy of topical ointments indicated for the treatment of the different clinico-pathologic variants of AK (focusing on tirbanibulin and 5-Fluorouracil 0.5%, Salicylic Acid 10%), providing a clinical, dermoscopic and OCT longitudinal evaluation.
Key message: the use of non-invasive diagnostic technique allowed us to classificate AK and choose a tailored treatment for each patients
