1. Information about this Guideline – Actinic keratosis and squamous cell carcinoma of the skin
1.1 Editors
The German Guideline Program in Oncology (GGPO) organized by the Association of the Scientific Medical Societies in Germany (AMWF), the German Cancer Society (DKG), and the German Cancer Aid Foundation (DKH).
1.2 Leading Scientific Societies
Deutschen Krebsgesellschaft (DKG) vertreten durch die Arbeitsgemeinschaft Dermatologische Onkologie (ADO)
Deutsche Dermatologische Gesellschaft (DDG)
1.3 Funding of the Guideline
This guideline was sponsored by the German Cancer Aid Foundation (DKH) within the framework of the German Guideline Program in Oncology.
1.4 Contact
Office Leitlinienprogramm Onkologie
c/o Deutsche Krebsgesellschaft e. V.
Kuno-Fischer-Str. 8
14057 Berlin
leitlinienprogramm@krebsgesellschaft.de
www.leitlinienprogramm-onkologie.de
1.5 How to cite
Leitlinienprogramm-Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Actinic keratosis and squamous cell carcinoma of the skin, Langversion 2.0, 2022, AWMF-Registernummer 032/022OL, https://www.leitlinienprogramm-onkologie.de/leitlinien/aktinische-keratose-und-plattenepithelkarzinom-der-haut
1.6 Previous Changes of Version 2.0
1.7 Special Comment
The field of medicine is subject to a continuous process of further development, so that all details provided here, and in particular those on diagnostic and therapeutic procedures, can always only represent the state of knowledge at the time when the medical care guideline was printed. The greatest possible care has been taken with regard to the treatment recommendations given and to the choice and dosage of drugs. However, users are requested to check by referring to the patient package inserts and specialist information provided by the manufacturers, and in cases of doubt to consult a specialist. In the general interest of the guideline editors, readers are requested to draw attention to any questionable points or inconsistencies found.
Users themselves remain responsible for all diagnostic and therapeutic applications, medications, and dosages.
Registered trademarks (protected proprietary names) are not specially identified in this guideline. The absence of an indication of this type can therefore not be taken to suggest that such names are unregistered product names.
All parts of this guideline are protected by copyright. Any usage outside of the provisions of copyright law without written permission from the German Guideline Program in Oncology editors is therefore unlawful and liable to prosecution. No part of this work may be reproduced in any form without written permission from the German Guideline Program in Oncology editors. This applies in particular to reproduction, translation, microfilming and storage, usage and exploitation in electronic systems, intranets and the Internet.
1.8 Objectives of the GGPO
The aim of the Association of the Scientific Medical Societies in Germany (AWMF), the German Cancer Society (DKG), and the German Cancer Aid Foundation (DKH) in implementing the German Guideline Program in Oncology (GGPO) is to jointly promote and support the development, updating, and use of scientifically based and practicable guidelines in oncology. The program is based on medical and scientific findings established by the specialist societies and the DKG, consensus among medical experts, users and patients, as well as the AMWF's regulations for guideline development. The program receives specialist support and financing from the German Cancer Aid. In order to reflect the current state of medical knowledge and to take account of medical progress, guidelines have to be regularly checked and updated. The use of the AWMF regulations is intended to provide a basis for developing of high-quality oncological guidelines in this framework. As guidelines represent an important instrument for quality assurance and quality management in oncology, they are intended to be used in a targeted and sustained way in everyday medical care. Active implementation measures and also evaluation programs are therefore important components of the support provided by the German Guideline Program in Oncology. The aim of the program is to create professional preconditions, with secure medium-term financing, for the development and provision of high-quality guidelines in Germany. High-quality guidelines of this type not only serve for structured knowledge transfer but can also be used in the design of health-care structures. Relevant aspects of this include evidence-based guidelines as a basis for establishing and updating disease management programs, and the use of quality indicators derived from guidelines in the context of certification procedures for organ tumor centers.
1.9 Additional Documents relating to this Guideline
In addition to this long version of the S3 guideline on actinic keratosis and squamous cell carcinoma of the skin, the following supplementary documents to this guideline are available:
- Short version of the guideline
- Patient guideline
- Guideline report on the guideline development process
- German Guideline Program in Oncology (https://www.leitlinienprogramm-onkologie.de/leitlinien/aktinische-keratose-und-plattenepithelkarzinom-der-haut)
- AWMF (https://www.awmf.org/leitlinien/detail/ll/032-022OL.html)
- Homepages of the participating professional societies (www.derma.de; ADO homepage)
- Guidelines International Network (www.g-i-n.net)
The guideline is also included in the German Guideline Program in Oncology app.
For more information, visit: https://www.leitlinienprogramm-onkologie.de/app/
1.10 Composition of the Guideline Group
1.10.1 Coordination and Reaction
Prof. Dr. Carola Berking, Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
Prof. Dr. Ulrike Leiter, Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
PD Dr. Markus Heppt, Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
Prof. Dr. Claus Garbe, Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
Editorial Assistance
Sarah Glandien, ADO/DeCOG Dermatologic Cooperative Oncology Group, Berlin, Germany
1.10.2 Involved Professional Societies and Organisations
Table 1 lists all of the involved professional societies and further organizations, as well as their mandated representatives.
Table 1: Beteiligte Fachgesellschaften und Organisationen
| Beteiligte Fachgesellschaften und Organisationen | Mandatsträger |
|---|---|
| Arbeitsgemeinschaft Dermatologische Histologie (ADH) | Prof. Dr. Michael Flaig |
| Arbeitsgemeinschaft Dermatologische Onkologie in der DKG und DDG (ADO) | Prof. Dr. Stephan Grabbe Prof. Dr. Axel Hauschild Prof. Dr. Ralf Gutzmer |
| Arbeitsgemeinschaft Dermatologische Prävention (ADP) | Yvonne de Buhr Elisa Großmann Henriette Bunde |
| Arbeitsgemeinschaft für Berufs- und Umweltdermatologie (ABD) | Prof. Dr. Andrea Bauer Prof. Dr. Swen Malte John |
| Arbeitsgemeinschaft Gesundheitsökonomie und Evidenz-basierte Medizin der DDG (AGED) | Prof. Dr. Matthias Augustin |
| Arbeitsgemeinschaft Palliativmedizin in der DKG (APM)_history | Prof. Dr. Carmen Loquai |
| Arbeitsgemeinschaft physikalische Diagnostik in der Dermatologie in der DDG | Prof. Dr. Julia Welzel PD Dr. Lutz Schmitz |
| Arbeitsgemeinschaft Radiologische Onkologie in der DKG (ARO) | Prof. Dr. Oliver Kölbl Prof. Dr. Dirk Vordermark |
| Arbeitsgemeinschaft Tumorklassifikation in der Onkologie der DKG (ATO) | Prof. Dr. Michael Weichenthal |
| Berufsverband Deutscher Dermatologen (BVDD) | Prof. Dr. Klaus Fritz |
| Berufsverband Deutscher Pathologinnen und Pathologen (BDP) | Prof. Dr. Stephan Ihrler |
| Beteiligte Fachexperten (ohne Stimmrecht) | Dr. Mareike Alter Prof. Dr. Jürgen Becker Prof. Dr. Eckhard W. Breitbart Prof. Dr. Thomas Dirschka Prof. Dr. Thomas Eigentler Dr. Michael Fluck Dr. Klaus Kraywinkel Dr. Christoph Löser Prof. Dr. Carmen Salavastru Prof. Dr. Heinz Schmidberger Dr. Claas Ulrich |
| Deutsche Dermatologische Gesellschaft (DDG) | Prof. Dr. Rolf-Markus Szeimies Prof. Dr. Eggert Stockfleth Prof. Dr. Julia Welzel |
| Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC) | Dr. Albrecht Krause-Bergmann |
| Deutsche Gesellschaft für Arbeitsmedizin und Umweltmedizin (DGAUM) | Prof. Dr. Hans Drexler Prof. Dr. Susanne Völter-Mahlknecht |
| Deutsche Gesellschaft für Chirurgie (DGCH) | Dr. Albrecht Krause-Bergmann |
| Deutsche Gesellschaft für Dermatochirurgie (DGDC) | Prof. Dr. Moritz Felcht |
| Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC) | Prof. Dr. Susanne Wiegand |
| Deutsche Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie (DGMKG) | PD Dr. Dr. Kai Wermker |
| Deutsche Gesellschaft für Palliativmedizin (DGP) | Prof. Dr. Dorothée Nashan |
| Deutsche Gesellschaft für Pathologie (DGP) | Prof. Dr. Stephan Ihrler |
| Deutsche Gesellschaft für Radioonkologie (DEGRO) | Prof. Dr. Oliver Kölbl Prof. Dr. Dirk Vordermark |
| Deutsche Gesellschaft für Ultraschall in der Medizin (DEGUM) | Prof. Dr. Stephan El Gammal |
| Deutsche gesetzliche Unfallversicherung (DGUV) | Steffen Krohn Dr. Michal Gina |
| Deutsche Röntgengesellschaft (DRG) | Prof. Dr. Christina Pfannenberg |
| Hautkrebsnetzwerk (Patientenvertretung) | Annegret Meyer Claudia Nink Antje Backes Hans-Walther Bötel |
The following professional societies and associations were contacted for the guideline process:
- Working Group Psycho-oncology of the German Cancer Society (PSO)
- Working Group Urological Oncology (AUO)
- Working Group Otorhinolaryngology, Oral and Maxillofacial Surgery in Oncology (AHMO)
- Working Group Oncology in Internal Medicine (AIO)
- German College of General Practitioners and Family Physicians (DEGAM)
- Association for Surgical Oncology (CAO)
- German Society for Hematology and Medical Oncology (DGHO)
- Working Group Rehabilitation in Dermatology (AReD)
However, they either did not respond, did not name a representative, or declined to participate.
1.10.3 Arbeitsgruppen
Table 2: Arbeitsgruppen
|
Arbeitsgruppe |
Mitglieder der Arbeitsgruppe (AG-Leiter fett markiert) |
|
Epidemiology and Etiology |
Ulrike Leiter, Rüdiger Greinert, Eckhard W. Breitbart, Thomas Eigentler, Klaus Kraywinkel, Claus Garbe, Jürgen Becker |
|
Diagnostics |
Michael Flaig, Julia Welzel, Christina Pfannenberg, Uwe Hillen, Stephan Ihrler, Thomas Dirschka, Markus Heppt, Lutz Schmitz |
|
Therapy of actinic keratosis |
Markus Heppt, Rolf-Markus Szeimies, Eggert Stockfleth, Klaus Fritz, Thomas Diepgen (verstorben), Carola Berking, Christoph Löser, Lutz Schmitz, Claas Ulrich, Carmen Salavastru, Theresa Steeb |
|
Therapy of invasive squamous cell carcinoma: Surgery |
Moritz Felcht, Kai Wermker, Albrecht Krause-Bergmann, Falk G. Bechara, Oliver Kölbl, Mareike Alter, Helmut Breuninger, Lukas Kofler, Susanne Wiegand, Ulrike Leiter |
|
Therapy of invasive squamous cell carcinoma: System therapy and palliative medicine |
Ralf Gutzmer, Axel Hauschild, Dorothée Nashan, Ulrike Leiter |
|
Therapy of invasive squamous cell carcinoma: Conservative therapy |
Ralf Gutzmer, Oliver Kölbl, Jürgen Becker, Ulrike Leiter, Dirk Vordermark, Axel Hauschild, Dorothée Nashan |
|
Prevention and aftercare |
Ulrike Leiter, Peter Mohr, Axel Hauschild, Klaus Fritz, Stephan El Gammal, Christina Pfannenberg, Swen Malte John |
|
Squamous cell carcinoma of the skin and/or actinic keratosis as occupational diseases |
Andrea Bauer, Rüdiger Greinert, Swen Malte John, Steffen Krohn, Eckhard W. Breitbart, Susanne Völter-Mahlknecht, Thomas Diepgen (verstorben) |
|
Therapy of cheilitis actinica |
Rolf-Markus Szeimies, Axel Hauschild, Ulrike Leiter, Carola Berking, Kai Wermker, Thomas Dirschka, Lutz Schmitz |
|
Therapy of squamous cell carcinoma in situ (Morbus Bowen) |
Lutz Schmitz, Markus Heppt, Michael Flaig |
1.10.4 Patient Involvement
Representatives of patient organizations (see Skin Cancer Network) were involved throughout the process of creating and updating this guideline.
1.10.5 Methodological Support
1. by the German Guideline Program in Oncology:
a. Markus Follmann, MD, MPH, MSc, Office of the German Guideline Program in Oncology - c/o German Cancer Society e.V.
b. Dipl. Soz.-Wiss. Thomas Langer, Office of the German Guideline Program in Oncology - c/o German Cancer Society e.V.
2. by the Association of the Scientific Medical Societies (AWMF)
a. Dr. Monika Nothacker, MPH, Association of the Scientific Medical Societies e.V.
1.11 Abkürzungsverzeichnis
Table 3: Abkürzungen
| Abkürzungen | Erläuterungen |
|---|---|
| 5-ALA | 5-aminolevulinic acid |
| 5-FU | 5-Fluorouracil |
| AFXL | Ablative fractional laser |
| AIN | Anal intraepithelial neoplasia |
| AJCC | American Joint Committee on Cancer |
| AK | Actinic Keratosis |
| ArbMedVV | Ordinance on Preventive Occupational Health Care |
| ArbSchG | Act on the Implementation of Measures of Occupational Safety and Health to Encourage Improvements in the Safety and Health Protection of Workers at Work |
| BKV | Ordinance on occupational diseases |
| CI | Confidence interval |
| HNSCC | head and neck squamous cell carcinoma |
| HPV | Human papilloma virus |
| HR | Hazard ratio |
| IGII | Investigator Global Improvement Index |
| ILDS | International League of Dermatological Societies |
| IMB | Ingenol mebutate |
| IPL | Intense pulsed light |
| KIN | Keratinocytic intraepidermal neoplasia |
| LED | Light-emitting diode |
| LN | Lymph node(s) |
| MAL | Methyl aminolevulinate |
| MRI (eng) | Magnetic resonance imaging |
| mSv | Millisievert |
| NCCN | National Comprehensive Cancer Network |
| NMSC | Non-Melanocytic Skin Cancer |
| OD | Occupational disease |
| pAIN | Perianal intraepithelial neoplasia |
| PDT | Photodynamic therapy |
| PET | Positron emission tomography |
| PGII | Patient Global Improvement Index |
| PIN | Penile intraepithelial neoplasia |
| PUVA | Psoralen plus UV-A |
| RCM | Reflectance confocal microscopy |
| RCT | Randomized Controlled Trial |
| ROS | Reactive Oxygen Species |
| SA | Salicylic acid |
| SCC | Squamous cell carcinoma or spinocellular carcinoma |
| SED | Standard erythema dose |
| SUV | Standardized uptake value |
| Syn. | Synonym |
| TCA | Trichloroacetic acid |
| TLNS | Target lesion number score |
| TLR | Toll-like receptor |
| UICC | Union Internationale Contre le Cancer (eng.: Union for International Cancer Control) |
| UV | Ultraviolet |
| VAKCC | Veteran Affairs Keratinocyte Carcinoma Chemoprevention Trial |
| VAS | Visual Analogue Scale |
| VIN | Vulvar intraepithelial neoplasia |
| vs. | versus |
| WHO | World Health Organization / Welt-Gesundheitsorganisation |