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Interview with Dr. Koscielny

Chief Medical Officer, Almirall

Written by Mark Nicholls

Actinic keratosis is one of the most common diagnoses made by dermatologists in Europe and its prevalence can be calculated to be around 18% of the population in this continent.

Actinic keratosis (AK) is a common skin condition caused by sun damage occurring mainly in skin areas chronically exposed to ultraviolet (UV) radiation. Despite being among the five most common diagnoses in dermatological consultations, it is still an underdiagnosed pathology.1

During the last years, an ageing population increased exposure to UV radiation and changes in UV-seeking behaviour2 have increased its prevalence to approximately 18% of the population in Europe.3,4

A precancerous condition

As the most common precancerous dermatological condition5, it is estimated that 40% to 80% of squamous cell carcinomas (SCC), the second most common form of skin cancer, evolve from simple AK lesions.6,7 Awareness is therefore key, as early diagnosis can stop the progression of the disease.

To help further increase knowledge of AK, Almirall, a global biopharmaceutical company focused on skin health, launched the first AK Global Day on May 24 in collaboration with Euromelanoma and AEDV Piel Sana. The global event, which will be held every year, aims to raise awareness of the importance of monitoring the appearance and evolution of AK skin lesions.

During the last years, an ageing population, increased exposure to UV radiation and changes in UV-seeking behaviour have increased its prevalence to approximately 18% of the population in Europe.

Dr Volker Koscielny, Almirall’s Chief Medical Officer, explains that “actinic keratosis is an underestimated condition. It is where cells in some exposed areas develop over time into cancerous cells. While we see morphological changes in the skin, people often dismiss it and do not take it seriously.”

The high prevalence of AK means the disease burden is substantial, especially in middle-aged and elderly populations. “People are stoic, they dismiss it just as spots they get when they are older, but the sun exposes change in the genetic profile of cells and over a 10-year period there is a 17% risk of developing a certain type of skin cancer. That is not negligible,” states Dr Koscielny.

Biggest risk factors

Due to the recurrent and unpredictable nature of the disease, early detection and treatment is essential to reduce the consequences for patients. The potentially precancerous condition of the disease means that lesions can progress to squamous cell carcinoma (SCC) if not adequately monitored.

In the same vein, Dr Koscielny points out that “as the impetus to go to a doctor and be checked out and diagnosed is not always there, awareness is absolutely crucial. This is a chronic condition that you cannot cure, so people must take it seriously. Doctors need to be clear to patients that this is not an aesthetic condition, it is one that has potentially serious consequences.”

Potential consequences

While the core lesion is visible and can be removed, the ‘field’ around these lesions should be treated as the cells may be disturbed and could become cancerous. AK can also affect patients’ quality of life, as lesions can cause cosmetic discomfort and interfere with the patient’s daily activities. “Doctors must be very clear with patients about what to expect and educate them about the potential consequences,” emphasises Dr Koscielny.

[1] Ferrándiz C, Plazas MJ, Sabaté M, Palomino R; EPIQA Study Group. Prevalence of actinic keratosis among dermatology outpatients in Spain. Actas Dermosifiliogr.2016 Oct;107(8):674-80. 
[2] Chetty P, Choi F, Mitchell T. Primary care review of actinic keratosis and its therapeutic options: a global perspective. Dermatol Ther (Heidelb) 2015; 5(1): 19-35
[3] Lucas R, McMichael T, Smith W, Armstrong B. Solar ultraviolet radiation: Global burden of disease from solar ultraviolet radiation: World Health Organization, 2006. 
[4] Worldometer. Population of Europe. 2020. Available at: https://www.worldometers.info/world-population/europe-population/ Accessed: October 2020. 
[5] Skin Cancer Foundation. Actinic Keratosis Overview. Available at: https://www.skincancer.org/skin-cancer-information/actinic-keratosis/#:~:text=Actinic%20keratosis%20(AK)%20is%20the,to%20ultraviolet%20(UV)%20radiation January 2021
[6] Stockfleth, E., et al. (2015). Physician perceptions and experience of current treatment in actinic keratosis. Journal of the European Academy of Dermatology and Venereology : JEADV, 29(2), 298–306. https://doi.org/10.1111/jdv.12530
[7] Fernández-Figueras, M. T., et al. (2015). Actinic keratosis with atypical basal cells (AK I) is the most common lesion associated with invasive squamous cell carcinoma of the skin. Journal of the European Academy of Dermatology and Venereology : JEADV, 29(5), 991–997. https://doi.org/10.1111/jdv.12848

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