Expert Consensus-Based Recommendations on the Use of Photodynamic Therapy in Actinic Keratosis Patients
Authors: Patel Vishal , Arron Sarah , Berman Brian , Chapman Michael Shane , Jambusaria-Pahlajani Anokhi , Martin George , Rossi Anthony , Schlesinger Todd , Zeitouni Nathalie , Bhatia Neal 
Published: November 2024

Expert Consensus-Based Recommendations on the Use of Photodynamic Therapy in Actinic Keratosis Patients
Vishal A. Patel, MD1; Sarah T. Arron, MD2; Brian Berman, MD, PhD3; M. Shane Chapman, MD, MBA4; Anokhi Jambusaria-Pahlajani, MD5; George Martin, MD6; Anthony M. Rossi, MD7; Todd Schlesinger, MD8; Nathalie C. Zeitouni, MDCM9; Neal Bhatia, MD10

1Department of Dermatology, George Washington University School of Medicine & Health Sciences, Washington, DC; 2Peninsula Dermatology, Burlingame, CA; 3University of Miami Miller School of Medicine, Miami, FL; Center for Clinical and Cosmetic Research, Aventura, FL; 4Department of Dermatology, Dartmouth Hitchcock Medical Center, Nashua, NH; Geisel School of Medicine at Dartmouth, Lebanon and Hanover, NH; 5Division of Dermatology, Department of Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, TX; 6Dr. George Martin Dermatology Associates, Kihei, HI; 7Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY; New York Presbyterian Hospital, New York, NY; 8Clinical Research Center of the Carolinas, Charleston, SC; 9Medical Dermatology Specialists, Phoenix, AZ; University of Arizona COM, Phoenix, AZ; 10Therapeutics Clinical Research, San Diego, CA

Background: Actinic keratoses (AKs) are common premalignant skin lesions that can progress to cutaneous squamous cell carcinomas, especially in individuals who have a history of prior AK diagnoses. Photodynamic therapy (PDT) is an effective and safe treatment for AKs and can treat large areas of field cancerization. While there are existing AAD guidelines published on the treatment of AKs, the authors wanted to further explore the treatment of AKs with PDT.

Methods: A systematic literature review surrounding PDT and AK was performed using PubMed, pulling relevant articles from between 1990-2023 using exploded Medical Subject Heading (MeSH) terms and keywords. Based on these articles, consensus statements were developed by professional medical writers. Ten expert dermatologists were recruited for this consensus group. An electronic questionnaire with the consensus statements were sent to panelists to vote on using a modified Delphi method. Each panelist was asked to rate each statement on a three-point Likert-type scale of disagree, slightly agree and strongly agree. For consensus to be established, ≥70% of panelists must strongly agree on the statement. If the threshold was not reached, the statement was revised and sent out for another round of voting. An anonymous virtual meeting was convened to discuss outstanding statements.

Results: A total of ten dermatology experts were recruited for the consensus group and a total of three rounds of voting were completed. An anonymous virtual meeting was convened in December 2023 after two rounds of voting to discuss and amend outstanding statements. A total of 55 consensus statements were established in many facets of PDT in AK, including lesion vs. field-directed therapy, cosmetic outcomes, patient selection, patient preference, choice of photosensitizer, incubation time, light source, painless PDT protocols, and PDT in organ transplant recipients and the elderly. A select number of consensus statements are presented.

Conclusion: Through this consensus group, we were able to develop a more comprehensive set of recommendations for the use of PDT in AKs. These recommendations can provide guidance for clinicians and bridge gaps in existing knowledge.

This study was funded by an unrestricted grant from Biofrontera, Inc.