Structured Expert Consensus on Actinic Keratosis: Treatment Algorithm Focusing on Daylight PDT

Piergiacomo Calzavara-Pinton (Lead / Corresponding author), Merete Hædersdal, Kirk Barber, Nicole Basset-Seguin, María Emilia del Pino Flores, Peter Foley, Gaston Galimberti, Rianne Gerritsen, Yolanda Gilaberte, Sally Ibbotson, Ketty Peris, Sheetal Sapra, Eleni Sotiriou, Luis Torezan, Claas Ulrich, Jonathan Guillemot, Janek Hendrich, Rolf-Markus M. Szeimies

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Background: A practical and up-to-date consensus among experts is paramount to further improve patient care in actinic keratosis (AK).

Objectives: To develop a structured consensus statement on the diagnosis,
classification and practical management of AK based on up-to-date information.

Methods: A systematic review of AK clinical guidelines was conducted. This
informed the preparation of a three-round Delphi procedure followed by a consensus meeting, which combined the opinions of 16 clinical experts from 13 countries, to construct a structured consensus statement and a treatment algorithm positioning daylight photodynamic therapy (dl-PDT) among other AK treatment options.

Results: The systematic review found deficiencies in current guidelines with respect to new AK treatments such as ingenol mebutate and daylight photodynamic therapy. The Delphi panel established consensus statements across definition, diagnosis, classification and management of AK. While the diagnosis of AK essentially rests on the nature of lesions, treatment decisions are based on several clinical and non-clinical patient factors and diverse environmental attributes. Participants agreed on ranked treatment preferences for the management of AK, and on classifying AK in three clinical situations: isolated AK lesions requiring lesion-directed treatment; multiple lesions within a small field and multiple lesions within a large field, both requiring specific treatment approaches. Different AK treatment options were discussed for
each clinical situation.
Conclusions: The results provide practical recommendations for the treatment of AK, which are readily transferable to clinical practice, and incorporate the physician’s clinical judgement. The structured consensus statement positioned dl-PDT as a valuable option for patients with multiple AKs in small or large fields.
Original languageEnglish
Pages (from-to)3s-16s
Number of pages14
JournalJournal of Cutaneous Medicine and Surgery
Issue number1
Early online date13 Apr 2017
Publication statusPublished - 1 May 2017


  • Actinic keratosis
  • Consensus
  • Treatment algorithm
  • Delphi methodology


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