光化性角化病和皮肤鳞状细胞癌。
Actinic Keratosis and Cutaneous Squamous Cell Carcinoma.
机构信息
Skin Cancer Center Hannover, Department of Dermatology, Hannover Medical School; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig; Department of Radiotherapy, University Hospital Regensburg; Department of Oromaxillofacial, Plastic and Esthetic Surgery, Osnabrück Hospital GmbH, Osnabrück; Department of Dermatology and Allergology, University Hospital (LMU), Munich.
出版信息
Dtsch Arztebl Int. 2019 Sep 13;116(37):616-626. doi: 10.3238/arztebl.2019.0616.
BACKGROUND
Cutaneous squamous cell carcinoma (cSCC) and its precursors, actinic keratoses (AK), are common. Physicians of multiple specialties are confronted with their treatment.
METHODS
This review is based on publications retrieved by a selective search in PubMed, as well as on the German guidelines on AK and cSCC, skin cancer prevention, and surgery with histologic guidance.
RESULTS
Local treatments for AK include lesional cryotherapy, curettage, and laser ablation as well as field-directed treatments with topical agents, e.g., diclofenac plus hyaluronic acid, imiquimod, 5-fluorouracil, ingenol mebutate, and photodynamic therapy. These treatments can be administered in various sequences or combinations, depending on individual factors and the stage of the disease. The gold standard of treatment for cSCC is histologically confirmed complete resection; radiotherapy is an alternative. Locally uncontrollable or metastatic disease is treated with systemic drugs. The use of various chemotherapeutic agents, EGFR-directed therapies, and the PD-I inhibitor cemiplimab, either singly or in combination, has been described in uncontrolled trials and case series. Cemiplimab has a reported response rate of 47% and was recently approved for the treatment of advanced cSCC.
CONCLUSION
There are many options for the treatment of AK and cSCC that must be considered in the interdisciplinary care of these entities.
背景
皮肤鳞状细胞癌（cSCC）及其前体光化性角化病（AK）较为常见，许多不同专业的医生都要面对它们的治疗问题。
方法
本综述基于在 PubMed 中进行选择性检索获得的文献，以及德国 AK 和 cSCC、皮肤癌预防、组织学引导下手术的指南，对 AK 和 cSCC 的治疗进行了总结。
结果
AK 的局部治疗包括皮损冷冻疗法、刮除术和激光消融术，以及外用药物的区域治疗，如双氯芬酸加透明质酸、咪喹莫特、5-氟尿嘧啶、 ingenol mebutate 和光动力疗法。这些治疗方法可以根据个人因素和疾病阶段以不同的顺序或组合进行。cSCC 的治疗金标准是组织学证实的完全切除；放疗是另一种选择。局部不可控制或转移性疾病采用全身药物治疗。各种化疗药物、EGFR 靶向治疗药物以及 PD-1 抑制剂西米普利单抗的单独或联合应用已在非对照试验和病例系列中得到描述。西米普利单抗的客观缓解率为 47%，最近被批准用于治疗晚期 cSCC。
结论
AK 和 cSCC 的治疗方法有很多种，在这些疾病的跨学科治疗中需要综合考虑。
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