Philipp-Dormston W G, Aschoff R, von Braunmühl T, Eigentler T, Haalck T, Thoms K-M
Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Deutschland.
Hautzentrum Köln, Klinik Links vom Rhein, Schillingsrotter Str. 39-41, 50996, Köln, Deutschland.
Hautarzt. 2021 Apr;72(4):314-320. doi: 10.1007/s00105-020-04731-y.
Actinic keratosis (AK), which frequently affects larger skin areas (field cancerization), is characterized by chronic course. Weighing therapy-specific advantages and disadvantages of field-oriented therapy for individual patients is challenging.
The main objective was the development of patient-oriented decision criteria for the pragmatic classification of field-directed AK treatment options in patients with a predisposition for field cancerization (patient types 1-3).
The development of the decision criteria and patient typology was based on a nominal respectively structured multilevel group process. The developed algorithm was then subsequently applied for the systematic evaluation of field-directed AK therapies.
Patient-relevant criteria for the treatment decision included (among others): effectiveness, selectivity, safety, duration of therapy, cosmesis, patient preference and comorbidities. With regard to the decision criteria and patient types in which field therapy was the treatment of choice, daylight photodynamic therapy notably met the requirement profile.
The definition of patient-relevant and therapy-related decision criteria in AK field therapy allows a systematic yet practice-oriented approach to classify specific treatment options and to derive individual treatment decisions.
光化性角化病（AK）常累及较大皮肤区域（场癌化），病程呈慢性。权衡针对个体患者的场定向治疗的特定治疗利弊具有挑战性。
主要目的是制定以患者为导向的决策标准，用于对有场癌化倾向的患者（1 - 3型患者）的场定向AK治疗方案进行务实分类。
决策标准和患者类型的制定基于名义上或结构化的多级分组过程。然后将所开发的算法应用于场定向AK治疗的系统评估。
治疗决策中与患者相关的标准包括（尤其）：有效性、选择性、安全性、治疗持续时间、美容效果、患者偏好和合并症。就场治疗为首选治疗方法的决策标准和患者类型而言，日光光动力疗法显著符合要求。
AK场治疗中与患者相关及与治疗相关的决策标准的定义，允许采用系统且以实践为导向的方法对特定治疗方案进行分类，并做出个体化治疗决策。
