Overview
Keratinocytic epidermal carcinomas encompass actinic keratoses, Bowen's disease, and basal cell carcinoma, representing non-melanoma skin cancers arising from keratinocytes. These conditions require timely intervention to prevent progression and potential complications 1.Diagnosis
Clinical examination identifying characteristic lesions (scaling patches, nodules, or plaques) 1.
Dermoscopy for distinguishing between different keratinocytic lesions 1.
Biopsy for histopathological confirmation, grading severity based on depth and extent of invasion 1.Management
First-line treatments:
- Photodynamic therapy (PDT) for in situ forms, using standardized protocols with narrow-spectrum light sources or daylight 1.
- Surgical excision for larger or more invasive lesions 1.
Adjunctive treatments:
- Topical therapies (e.g., 5-fluorouracil, imiquimod) for superficial lesions 1.
- Cryotherapy as an adjunct or alternative for smaller lesions 1.Special Populations
Pregnancy: Limited evidence; PDT using daylight may be preferred due to reduced pain and higher patient acceptance, but caution advised 1.
Elderly: PDT remains effective; consider comorbidities affecting light sensitivity or healing capacity 1.Key Recommendations
Use photodynamic therapy (PDT) as a first-line treatment for in situ keratinocytic skin cancers, utilizing daylight for enhanced patient comfort and acceptance (Evidence: Strong 1).
Consider surgical excision for larger or more invasive basal cell carcinomas to ensure complete removal (Evidence: Moderate 1).
For superficial lesions, topical agents like 5-fluorouracil or imiquimod can be effective adjuncts to primary treatment strategies (Evidence: Moderate 1).References
1 Balakirski G, Lehmann P, Szeimies RM, Hofmann SC. Photodynamic therapy in dermatology: established and new indications. Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG 2024. link