Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Division of Dermatology, Department of Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, Texas.
J Am Acad Dermatol. 2020 Sep;83(3):719-730. doi: 10.1016/j.jaad.2020.03.127. Epub 2020 May 6.
The goal of field cancerization treatment is to reduce the risk of developing keratinocyte carcinoma. Selecting the appropriate therapy depends on the degree of field cancerization and the number of invasive cutaneous squamous cell carcinomas. Other considerations include treatment efficacy, cost, side effects, and patient preference. Field therapies are preferred because they address clinically visible disease and subclinical atypia. However, lesion-directed therapies are useful for lesions that are more difficult to treat or those where a histologic diagnosis is required. Patients with extensive field cancerization benefit from a combination of field-directed and lesion-directed treatments. The second article in this continuing medical education series provides a framework to guide evidence-based decision making for field cancerization treatment.
[正文] 治疗癌前病变的目的是降低发展为角质形成细胞癌的风险。选择合适的治疗方法取决于癌前病变的程度和侵袭性皮肤鳞状细胞癌的数量。其他需要考虑的因素包括治疗效果、成本、副作用和患者的偏好。由于能够解决临床可见的疾病和亚临床异型性,因此倾向于使用局部治疗。然而,对于更难治疗的病变或需要组织学诊断的病变,病变定向治疗是有用的。广泛的癌前病变患者受益于联合使用局部定向和病变定向治疗。本继续教育系列的第二篇文章提供了一个框架,用于指导基于证据的癌前病变治疗决策。