| 1. |
- Dahlén Gyllencreutz, Johan, et al.
(författare)
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Diagnostic agreement and interobserver concordance with teledermoscopy referrals
- 2017
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Ingår i: Journal of the European Academy of Dermatology and Venereology. - : Wiley. - 0926-9959 .- 1468-3083. ; 31:5, s. 898-903
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundMalignant melanoma and non-melanoma skin cancers are among the fastest increasing malignancies in many countries. With the help of new tools, such as teledermoscopy referrals between primary health care and dermatology clinics, the management of these patients could be made more efficient. ObjectiveTo evaluate the diagnostic agreement and interobserver concordance achieved when assessing referrals sent through a mobile teledermoscopic referral system as compared to referrals sent via the current paper-based system without images. MethodsThe referral information from 80 teledermoscopy referrals and 77 paper referrals were evaluated by six Swedish dermatologists. They were asked to answer questions about the probable diagnosis, the priority, and a management decision. ResultsTeledermoscopy generally resulted in higher diagnostic agreement, better triaging and more malignant tumours being booked directly to surgery. The largest difference between the referral methods was seen for invasive melanomas. Referrals for benign lesions were significantly more often correctly resent to primary health care with teledermoscopy. However, referrals for cases of melanoma in situ were also incorrectly resent five times. The interobserver concordance was moderate with both methods. ConclusionBy adding clinical and dermoscopic images to referrals, the triage process for both benign and dangerous skin tumours can be improved. With teledermoscopy, patients with melanoma especially can receive treatment more swiftly.
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| 2. |
- Stenman, Caroline, et al.
(författare)
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Degree of differentiation of cutaneous squamous cell carcinoma: a comparison between a Swedish cohort of organ transplant recipients and immunocompetent patients.
- 2018
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Ingår i: Dermatology practical & conceptual. - : Mattioli1885. - 2160-9381. ; 8:4, s. 330-336
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Tidskriftsartikel (refereegranskat)abstract
- Organ transplant recipients (OTRs) have a very high risk of developing cutaneous squamous cell carcinoma (cSCC). Immunosuppressed OTRs may have a higher proportion of poorly differentiated cSCC than non-OTRs.The aim of this study was to investigate the degree of differentiation of cSCCs in OTRs compared with immunocompetent individuals.Data from the Swedish Cancer Registry were crosschecked with data from the Transplant registry of the Transplant Institute at Sahlgrenska University Hospital in Gothenburg, Sweden. All OTRs with a diagnosis of cSCC, basosquamous carcinoma, and/or cSCC in situ established at the Department of Dermatology, Sahlgrenska University Hospital, during 2002-2015 were included. The control group consisted of non-OTRs with the same diagnoses during the same time period.During 2002-2015, 82 OTRs diagnosed with 515 tumors and 883 non-OTRs with 1,247 tumors were included. OTRs developed 0.47 tumors/year vs 0.10 tumors/year for non-OTRs, but no significant differences were observed in the degree of tumor differentiation of invasive cSCCs between OTRs and non-OTRs (P = 0.4). The distribution of poorly, moderately, and well-differentiated invasive cSCCs among OTRs and non-OTRs were 8.5% vs 12.5%, 22.1% vs 29.9%, and 69.4% vs 57.6%, respectively.OTRs do not develop a higher proportion of poorly differentiated cSCCs than non-OTRs.
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| 3. |
- Öhman, Jenny, et al.
(författare)
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Oral and lip cancer in solid organ transplant patients--a cohort study from a Swedish Transplant Centre.
- 2015
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Ingår i: Oral oncology. - : Elsevier BV. - 1879-0593 .- 1368-8375. ; 51:2, s. 146-50
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Tidskriftsartikel (refereegranskat)abstract
- Previous large studies have shown that solid organ transplant (SOT) patients have an increased risk of developing malignancies. Few studies have compared the prognosis for SOT patients who develop cancer with that of non-transplanted cancer patients. In this study we have investigated the increased risk of oral and lip cancer in SOT patients and also compared the relative survival between SOT patients and non-SOT patients with oral and lip cancer.
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| 4. |
- Claeson, Magdalena, 1976, et al.
(författare)
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Incidence of cutaneous melanoma in Western Sweden, 1970-2007.
- 2012
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Ingår i: Melanoma research. - 1473-5636. ; 22:5, s. 392-8
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe the increasing incidence of cutaneous malignant melanoma (CMM) in Western Sweden during the period 1970-2007. A secondary aim was to show a geographical variation in incidence between coastal and inland areas, considering the effects of the local average duration of sunshine, and the sun exposure-related behavior in the populations. The Swedish Cancer Registry provided data on invasive melanomas during 1970-2007. Meteorological maps showed the annual average duration of sunshine during 1961-1990. A survey from 2007 with 2871 participants, carried out by the National Board of Health and Welfare, provided data on self-reported sun exposure. During the period studied, the age-standardized incidence for men in Western Sweden more than quadrupled to 31.1/100 000 inhabitants, whereas it tripled for women to 27.1/100 000. Coastal areas, including Gothenburg city, had a high average duration of sunshine (1701-1900 h of sun/year), whereas inland areas had lower average duration of sunshine (≤1700 h). The incidence of CMM was higher in coastal areas and in Gothenburg city, compared with inland areas. This may be linked to ultraviolet radiation, a consequence of the higher average duration of sunshine. The sun exposure survey showed additional factors, which possibly led to the increased incidence, for example high sun exposure on holidays abroad. The alarming increase in the incidence of CMM in Western Sweden, during the period 1970-2007, shows the need for additional primary preventive measures, for example sun protection programs targeted at populations in this area.
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| 5. |
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| 6. |
- Claeson, Magdalena, 1976, et al.
(författare)
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Modelling the Future: System Dynamics in the Cutaneous Malignant Melanoma Care Pathway
- 2016
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Ingår i: Acta dermato-venereologica. - : Medical Journals Sweden AB. - 1651-2057 .- 0001-5555. ; 96:2, s. 181-185
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Tidskriftsartikel (refereegranskat)abstract
- Incidence rates for cutaneous malignant melanoma are increasing worldwide. Estimates of the future number of melanoma cases are important for strategic planning of the care pathway. The aim of this study was to use system dynamics modelling to evaluate the long-term effects of changes in incidence, population growth and preventive interventions. Historical data on invasive melanoma cases in Western Sweden from 1990 to 2006 were obtained. Using computer simulation software, a model estimating the accumulated number of melanoma cases for 2014 to 2023 was developed. Five future scenarios were designed: stable incidence, business-as-usual, 25% reduced patient's delay, 50% reduced doctor's delay, and a combination of the last 2, called improved overall secondary prevention. After 10 years, improved overall secondary prevention would have resulted in a 42% decrease in melanomas >4 mm and a 10% increase in melanomas ≤1 mm, compared with business-as-usual. System dynamics is a valuable tool, which can help policymakers choose the preventive interventions with the greatest impact.
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| 7. |
- Claeson, Magdalena, 1976, et al.
(författare)
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Multiple primary melanomas in Western Sweden; 1990-2013
- 2016
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Ingår i: 3rd International Conference on UV and Skin Cancer Prevention, Melbourne.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- IntroductionIn Sweden, the incidence of cutaneous malignant melanoma rises yearly with 5.5% for men and 5.2% for women and has now reached world standard rates of 17.6 for men and 18.8 for women per 100,000 population. Over the past decades, the incidence of melanoma has been higher in Western Sweden than the national average. Previous international studies have shown that melanoma patients have an elevated risk of developing a new separate primary melanoma. This study aimed at describing multiple primary melanomas (MPMs) in Western Sweden with focus on the number of tumours detected, tumour characteristics and the time to diagnosis of a subsequent melanoma.MethodsData was extracted retrospectively from the Swedish Melanoma Registry and provided information on all invasive and in situ melanoma cases in Western Sweden (1.6 million inhabitants) from 1990 to 2013. Results Within the studied period, 12,152 patients developed 13,291 melanomas. 11,254 of the patients developed only a single primary melanoma. In total, 898 patients (7.4% of all melanoma patients) developed 2,037 MPMs. Preliminary results show that the median Breslow thickness for all invasive melanomas was below 1 mm. The median Breslow thickness for the MPMs was slightly thinner for the second and third invasive melanoma as compared to the first invasive melanoma. Further, there was a higher percentage of in situ tumours among the subsequent melanomas. The median time to diagnosis of a subsequent melanoma was approximately 3 years. DiscussionSubsequent primary melanomas in Western Sweden are most commonly diagnosed with a somewhat thinner Breslow thickness than the first primary melanoma. The comparatively high percentage of melanoma survivors developing MPMs and the short median time to diagnosis of a subsequent melanoma stresses the importance of follow-up for melanoma patients, particularly during the first years.
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| 8. |
- Claeson, Magdalena, 1976, et al.
(författare)
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MultiplePrimary Melanomas: A Common Occurrencein Western Sweden.
- 2017
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Ingår i: Acta dermato-venereologica. - : Medical Journals Sweden AB. - 1651-2057 .- 0001-5555. ; 97:6, s. 715-719
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Tidskriftsartikel (refereegranskat)abstract
- Patients diagnosed with a single primary cutaneous melanoma are at increased risk of developing multiple primary melanomas. The aim of this study is to describe the epidemiology of multiple primary melanomas (invasive and in situ) in Western Sweden. Data from the Swedish Melanoma Registry from 1990 to 2013 revealed that 898 patients (7.4%) developed 2,037 multiple primary lesions and 11,254 patients developed single lesions. The proportion of subsequent lesions that were melanoma in situ was 47%, compared with 26% of first melanomas (p<0.0001). The median time to diagnosis of a subsequent melanoma was 38 months (95% confidence interval (CI), 53-62 months). In total, 49% of subsequent melanomas were detected within 3 years. Patients and physicians should be aware of the high proportion of multiple primary melanomas in Western Sweden, especially during the first years of follow-up.
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| 9. |
- Gonzalez, Helena, 1971, et al.
(författare)
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Percutaneous absorption of the sunscreen benzophenone-3 after repeated whole-body applications, with and without ultraviolet irradiation
- 2006
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Ingår i: Br J Dermatol. - : Oxford University Press (OUP). - 0007-0963. ; 154:2, s. 337-40
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Benzophenone-3 (BZ-3; 2-hydroxy-4-methoxybenzophenone, oxybenzone) is commonly used to absorb ultraviolet (UV) radiation. BZ-3 penetrates the skin and can be found in the urine. The amount varies between 0.4% and 2%. This seems to be the main metabolic pathway in rats. OBJECTIVES: To investigate the total amount of BZ-3 excreted in the urine after repeated topical whole-body applications of a sunscreen and to see if UV radiation has any effect on the amount excreted. METHODS: Twenty-five volunteers applied a commercially available sunscreen containing 4% BZ-3 morning and night for 5 days. Their urine was measured during those 5 days and during a further 5 days after the last application. They were divided into groups A (unirradiated) and B. Group B received UV radiation according to skin type: UVA between 400 and 707 J cm(-2), and UVB between 0.46 and 2.0 J cm(-2). BZ-3 in urine was analysed with a high-performance liquid chromatography method. RESULTS: The volunteers excreted 1.2-8.7% (mean 3.7%) of the total amount of BZ-3 applied. There was no significant difference between the two groups (P < 0.99, t-test). CONCLUSIONS: We show that a large amount of BZ-3 is absorbed. BZ-3 is accumulated in the body as the volunteers excreted BZ-3 5 days after the last application.
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| 10. |
- Gonzalez, Helena, 1971
(författare)
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Percutaneous absorption with emphasis on sunscreens.
- 2010
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Ingår i: Photochemical & photobiological sciences : Official journal of the European Photochemistry Association and the European Society for Photobiology. - : Springer Science and Business Media LLC. - 1474-9092. ; 9:4, s. 482-8
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Tidskriftsartikel (refereegranskat)abstract
- Sunscreens are widely used products. When recreationally used they are applied to large areas of the skin repeatedly. In moisturizers and foundation it is common to find sun protective ingredients, in these cases the product is usually applied to smaller areas but often done daily. Active ingredients in sunscreens can be absorbed by the skin. Percutaneous absorption is an important factor to take into consideration. There are several methods to measure the percutaneous absorption, both in vivo and/or in vitro. This paper will give an overview of the different methods.
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| 11. |
- Gonzalez, Helena, 1971, et al.
(författare)
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Photostability of commercial sunscreens upon sun exposure and irradiation by ultraviolet lamps
- 2007
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Ingår i: BMC Dermatol. - 1471-5945. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Sunscreens are being widely used to reduce exposure to harmful ultraviolet (UV) radiation. The fact that some sunscreens are photounstable has been known for many years. Since the UV-absorbing ingredients of sunscreens may be photounstable, especially in the long wavelength region, it is of great interest to determine their degradation during exposure to UV radiation. Our aim was to investigate the photostability of seven commercial sunscreen products after natural UV exposure (UVnat) and artificial UV exposure (UVart). METHODS: Seven commercial sunscreens were studied with absorption spectroscopy. Sunscreen product, 0.5 mg/cm2, was placed between plates of silica. The area under the curve (AUC) in the spectrum was calculated for UVA (320-400 nm), UVA1 (340-400 nm), UVA2 (320-340 nm) and UVB (290-320 nm) before (AUCbefore) and after (AUCafter) UVart (980 kJ/m2 UVA and 12 kJ/m2 of UVB) and before and after UVnat. If theAUC Index (AUCI), defined as AUCI = AUCafter/AUCbefore, was > 0.80, the sunscreen was considered photostable. RESULTS: Three sunscreens were unstable after 90 min of UVnat; in the UVA range the AUCI was between 0.41 and 0.76. In the UVB range one of these sunscreens was unstable with an AUCI of 0.75 after 90 min. Three sunscreens were photostable after 120 min of UVnat; in the UVA range the AUCI was between 0.85 and 0.99 and in the UVB range between 0.92 and 1.0. One sunscreen showed in the UVA range an AUCI of 0.87 after UVnat but an AUCI of 0.72 after UVart. Five of the sunscreens were stable in the UVB region. CONCLUSION: The present study shows that several sunscreens are photounstable in the UVA range after UVnat and UVart. There is a need for a standardized method to measure photostability, and the photostability should be marked on the sunscreen product.
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| 12. |
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| 13. |
- Gonzalez, Helena, 1971
(författare)
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Studies of Sunscreens: Percutaneous Absorption of Benzophenone-3 and Photostability
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Studies of Sunscreens: Percutaneous Absorption of Benzophenone-3 and Photostability Helena Gonzalez Department of Dermatology and Venereology Institute of Clinical Sciences The Sahlgrenska Academy at Göteborg University Göteborg, Sweden Abstract Aim: To learn more about percutaneous absorption of the photoactive compound benzophenone-3 (BZ-3) and to study the excretion pattern of BZ-3 and its metabolite dihydroxy benzophenone (DHB). We also got the opportunity to develop a reverse-phase HPLC method to analyze BZ-3 and DHB. The photostability of seven commercial sunscreens was also studied. Material and methods: Paper I: 11 participants applied a sunscreen, 2 mg/cm2, containing 4% BZ-3. They collected urine for 48 hours after the application. Paper II: 26 participants applied a sunscreen, 2 mg/cm2, containing 4% BZ-3 morning and night for five days. Half of the participants were exposed to UV radiation (UVR). They collected urine for the five days the sunscreen was applied and an additional five days after the last application. Paper III: The assay uses: solid-phase extraction with C8 columns; a Genesis C18 column (4.6 mm x 150 mm ); a gradient acetonitrile-water mobile phase; a UV-detector set at 287 nm. Paper IV: Seven commercial sunscreens were studied with absorption spectrophotometry. Sunscreen product, 0.5 mg/cm2, was placed between plates of silica. The area under the curve (AUC) in the spectrum was calculated for the different UV regions. AUC before (AUCbefore) and after (AUCafter) artificial UV exposure and before and after natural UV exposure were calculated. If the AUC Index (AUCI), defined as AUCI=AUCafter/AUCbefore, was > 0.80, the sunscreen was considered photostable. Results: Paper I: The average total amount excreted was 11 mg, median 9.8 mg, which is approximately 0.4% of the applied amount BZ-3. Paper II: The volunteers excreted 1.2-8.7% BZ-3 of the total applied amount. The mean value found was 3.7%. There was no significant difference between the two groups; p<0.99. Paper III: The assay was linear r2 >0.99, with detection limits for BZ-3 and DHB of 0.01 µmol/l and 0.16 µmol/l respectively. Relative standard deviation was less than 10% for BZ-3 and less than 13% for DHB. The excretion pattern varied among the human volunteers, different patterns were discerned among the individuals. Paper IV: Three sunscreens were unstable after 90 min of natural UV, in the UVA range the AUCI was between 0.41 and 0.76. In the UVB range, one of these sunscreens was unstable with an AUCI of 0.75 after 90 min. Three sunscreens were photostable after 120 min of natural UV, in the UVA range the AUCI was between 0.85 and 0.99 and in the UVB range between 0.92 and 1.0. Conclusions: Paper I: BZ-3 is absorbed by the skin and excreted in the urine after one topical application of a sunscreen containing 4% BZ-3. There are individual differences in the amount excreted and in the excretion pattern. Paper II: Repeated topical applications of a sunscreen containing 4% BZ-3 lead to a higher excretion of BZ-3. There was no statistical difference after exposure to UVR. Paper III: The developed reverse-phase HPLC-method was reliable and suitable to handle a large number of samples. BZ-3 and DHB were excreted in a similar pattern. Paper IV: Three of the seven investigated sunscreens were photounstable in the UVA region. The combination ethylhexyl methoxycinnamate and butyl methoxydibenzoylmethane was unstable regardless of which other photoactive compound that was included in the sunscreen. Key words: benzophenone-3, dihydroxy benzophenone, sunscreens, UV radiation, reverse-phase HPLC, photostability
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| 14. |
- Hallberg, Stefan, 1955, et al.
(författare)
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Developing a simulation model for the patient pathway of cutaneous malignant melanoma
- 2015
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Ingår i: Operations Research for Health Care. - : Elsevier BV. - 2211-6923. ; 6, s. 23-30
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Tidskriftsartikel (refereegranskat)abstract
- In this study, a system dynamic simulation model for a part of the patient pathway of cutaneous malignant melanoma was developed. A model was built that produced quantified out-put of diagnosed patients staged by severity, using System dynamic simulation. Data from the Swedish Melanoma Registry were combined with current scientific results and used in this analytical tool. Solutions to how these results are adapted into a simulation are described. The simulation model has the ability to generate alternative quantitative output of patient health in a population corresponding to realistic interventions in health care programmes as well as population and incidence development.
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| 15. |
- Halldin, Christina, 1957, et al.
(författare)
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Nerve blocks enable adequate pain relief during topical photodynamic therapy of field cancerization on the forehead and scalp
- 2009
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Ingår i: British Journal of Dermatology. - 1365-2133. ; 160:4, s. 795-800
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Topical photodynamic therapy (PDT) is an effective method when treating extensive areas of sun-damaged skin with multiple actinic keratoses (AKs) (field cancerization) on areas such as the forehead and scalp, and offers excellent cosmetic outcome. The major side-effect of PDT is the pain experienced during treatment. OBJECTIVES: To investigate whether nerve blocks could provide adequate pain relief during PDT of AKs on the forehead and scalp. METHODS: Ten men with symmetrically distributed and extensive AKs on the forehead and scalp were included in the study. Prior to PDT one side of the forehead and scalp was anaesthetized by nerve blocks while the other side served as control. RESULTS: The mean visual analogue scale (VAS) score on the anaesthetized side was 1 compared with 6.4 on the nonanaesthetized side during PDT. This difference was significant (P<0.0001), implying that nerve blocks reduce VAS scores during PDT. CONCLUSIONS: The results of the study support the use of nerve blocks as pain relief during PDT of field cancerization on the forehead and scalp, although individual considerations must be taken into account to find the most adequate pain-relieving method for each patient.
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| 16. |
- Halldin, Christina, 1957, et al.
(författare)
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Patients' Experiences of Pain and Pain Relief During Photodynamic Therapy on Actinic Keratoses: An Interview Study.
- 2013
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Ingår i: Acta Dermato-Venereologica. - : Medical Journals Sweden AB. - 0001-5555. ; 93:4, s. 433-437
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Tidskriftsartikel (refereegranskat)abstract
- Photodynamic therapy (PDT) is a well-known, effective method for treating extensive areas of multiple actinic keratoses in the face and scalp. The main side-effect of PDT is the pain experienced during treatment. The objective of this study was to explore and describe patients' experiences of PDT. The study used individual interviews, and analysis was carried out using phenomenography. The patients had all been treated with PDT for actinic keratoses on the face and scalp, and experienced PDT with and without nerve blocks. The results are presented in 3 themes and 10 categories. Most patients reported that the nerve blocks given prior to PDT altered their experience of pain. Alternative options are needed to reduce pain during PDT based on patients' needs and body site. This study adds a patient perspective highlight-ing patients' own voices as a qualitative complement to statistical analysis using the visual analogue scale.
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| 17. |
- Halldin, Christina, 1957, et al.
(författare)
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Predictors of Pain Associated with Photodynamic Therapy: A Retrospective Study of 658 Treatments.
- 2011
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Ingår i: Acta dermato-venereologica. - : Medical Journals Sweden AB. - 0001-5555.
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Tidskriftsartikel (refereegranskat)abstract
- Pain is the most common side-effect of photodynamic therapy (PDT). Our main objective was to identify pain predictors in PDT. In total, we performed 658 treatments on 377 patients at our department during 2004. Larger sized treatment areas were the strongest pain predictor, and actinic keratoses were more painful to treat than basal cell carcinomas and Bowen's disease. The most sensitive areas to treat were the face and scalp. Gender and age did not influence pain. Although treatment outcome was not our primary objective, 62% of 95 superficial basal cell carcinomas that were followed for 3 years showed complete clearance. Also, perforation of nodular basal cell carcinomas did not lead to better clinical results. In conclusion, the size of the treatment area, the diagnosis and the lesion location influence pain during PDT. Never-theless, there is a large variance in visual analogue scale assessment within each group, thereby limiting the ability to predict pain.
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| 18. |
- Stenman, Caroline, et al.
(författare)
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Sun protection behaviour in organ transplant recipients and non-transplant patients attending a dermatology outpatient clinic in Sweden: A questionnaire survey
- 2022
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Ingår i: Photodermatology Photoimmunology & Photomedicine. - : Wiley. - 0905-4383 .- 1600-0781. ; 38:2, s. 132-140
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Tidskriftsartikel (refereegranskat)abstract
- Background/purpose Organ transplant recipients (OTRs) are at high risk of developing skin cancer and are therefore advised to protect their skin against ultraviolet radiation from the sun. Specialized OTR clinics with dermatological follow-up may improve sun habits among OTRs. In this study, we compared self-reported sun exposure and sun protection behaviour between OTRs and non-transplant patients (non-TPs) and between OTRs with and without special dermatological follow-up. Methods Patients from Sahlgrenska University Hospital, Gothenburg, Sweden, completed a sun exposure questionnaire. Between 2011 and 2015, 282 OTRs transplanted in the period 1976-2014 and 414 non-TPs were recruited among dermatological outpatients. Participants were stratified into five groups by their status as OTRs or non-TPs and by attendance to dermatological follow-up. Results More non-TPs than OTRs reported one or more sunburns in the past year, 46% vs. 20%, P < .0001). More OTRs with than OTRs without dermatological follow-up reported frequent use of sunscreens (63% vs 44%, P = .006). More OTRs with follow-up used one or more sun protection measure such as covering clothes, than other OTRs (54% vs 34%, P = .016). Conclusion In this study, OTRs reported less sun exposure than non-TPs. Specialized dermatological follow-up seems to improve sun protection behaviour among OTRs. We suggest that specialized OTR clinics should be more broadly implemented.
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| 19. |
- Togsverd-Bo, K., et al.
(författare)
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Photodynamic therapy is more effective than imiquimod for actinic keratosis in organ transplant recipients: a randomized intraindividual controlled trial
- 2018
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Ingår i: British Journal of Dermatology. - : Oxford University Press (OUP). - 0007-0963 .- 1365-2133. ; 178:4, s. 903-909
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Tidskriftsartikel (refereegranskat)abstract
- Background Actinic keratoses (AKs) in solid organ transplant recipients (OTRs) are difficult-to-treat premalignancies and comparison of topical therapies is therefore warranted. Objectives In an intraindividual study to compare the efficacy and safety of field treatment with methyl aminolaevulinate photodynamic therapy (MAL-PDT) and imiquimod (IMIQ) for AKs in OTRs. Methods OTRs (n = 35) with 572 AKs (grade I-III) in two similar areas on the face, scalp, dorsal hands or forearms were included. All patients received one MAL-PDT and one IMIQ session (three applications per week for 4 weeks) in each study area according to randomization. Treatments were repeated after 2 months (IMIQ) and 3 months (PDT) in skin with incomplete AK response. Outcome measures were complete lesion response (CR), skin reactions, laboratory results and treatment preference. Results The majority of study areas received two treatment sessions (PDT n = 25 patients; IMIQ n = 29 patients). At 3 months after two treatments, skin treated with PDT achieved a higher rate of CR (AK I-III median 78%; range 50-100) compared with IMIQ-treated skin areas (median 61%, range 33-100; P < 0.001). Fewer emergent AKs were seen in PDT-treated skin vs. IMIQ-treated skin (0.7 vs. 1.5 AKs, P = 0.04). Patients developed more intense inflammatory skin reactions following PDT, which resolved more rapidly compared with IMIQ (median 10 days vs. 18 days, P < 0.01). Patient preference (P = 0.47) and cosmesis (P > 0.30) were similar for PDT and IMIQ. Conclusions Compared with IMIQ, PDT treatment obtained a higher rate of AK clearance at 3-month follow-up and achieved shorter-lasting, but more intense, short-term skin reactions.
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