Clinical Dialogues: Actinic Keratosis and Other Nonmelanoma Skin Cancers

A supplement to Skin & Allergy News supported by an unrestricted educational grant from Valeant Pharmaceuticals International.
The Skin & Allergy News supplement, “Clinical Dialogues: Actinic Keratosis and Other Nonmelanoma Skin Cancers” is recognized by the American Academy of Dermatology for 1 hour of AAD Category 1 credit and may be used toward the American Academy of Dermatology's Continuing Medical Education Award.
Highlights of a clinical roundtable discussion that took place in Washington, DC, on February 7, 2004.

•Topics
•Faculty
•Target Audience
•Educational Needs
•Learning Objectives
•CME Recognition

To view the supplement, click the image above. To take the CME test, download and print out the PDF file, and follow the test instructions on page 14.

Topics

Skin Cancer, Topical Agents
Mechanisms of Topical Action
Managing Inflammation
Cheilitis, Cryotherapy
Photodynamic Therapy, Immunocompromised Patients
Bowen's Disease, Superficial Multifocal Basal Cell Carcinoma
Cost Considerations, Conclusions
Advances in the Treatment of Verruca Vulgaris
Faculty

Emil A. Tanghetti, MD, Chair
Clinical Professor of Dermatology
Department of Dermatology
University of California, Davis
Director, Center for Dermatology and Laser Surgery
Sacramento, Calif.
Funding: Valeant; Consultant: Allergan, Inc. and Valeant.

Bari B. Cunningham, MD
Assistant Clinical Professor of Pediatrics and Medicine (Dermatology)
University of California at San Diego
Director, Dermatologic Surgery
Children's Hospital and Health Center
San Diego, Calif.
Consultant: Valeant Pharmaceuticals International. She discusses the unlabeled use of imiquimod, squaric acid dibutylesterate, cantharidin, cimetidine, diphencyclopropenone, and candida vaccine for the treatment of warts in children.

Edward W.B. Jeffes, MD
Professor of Dermatology
Department of Dermatology
University of California, Irvine
Consultant: Amgen Inc. and Valeant.

Bruce E. Katz, MD
Clinical Professor of Dermatology
Department of Dermatology
Mt. Sinai School of Medicine
Director, Cosmetic Surgery and Laser Clinic
Mt. Sinai Hospital, New York
Nothing to disclose.

Robert A. Skidmore, MD
Associate Professor of Dermatology
Department of Dermatology
University of Florida
Gainesville
Discusses the unlabeled use of 5% 5-fluorouracil and imiquimod for the use of pre-malignant and malignant cutaneous lesions.

Abel Torres, MD. JD
Professor and Chief of Dermatology
Division of Dermatology
Loma Linda University
Loma Linda, Calif.
Funding: 3M Pharmaceuticals and Lucid, Inc.; Consultant: 3M and Valeant. He discusses the unlabeled use of imiquimod for basal cell carcinoma. He also discusses the unlabeled use of 5% 5-fluorouracil for squamous cell carcinoma.

William Philip Werschler, MD
Assistant Clinical Professor of Medicine and Dermatology
University of Washington, Seattle
Spokane Dermatology Clinic
Spokane, Wash.
Funding: Valeant.

Target Audience

This activity has been developed for dermatologists and other health care professionals who are involved in the diagnosis, treatment, and long-term management of patients with actinic keratosis (AK), basal cell carcinoma (BCC), squamous cell carcinoma (SCC) in situ, and verruca vulgaris.

Educational Needs

AKs, formed by proliferation of neoplastic keratinocytes, are considered by many in the field of dermatology to represent SCC in situ and are treated because of their potential to progress to invasive or metastatic SCC. The risk for metastasis is particularly strong in immunocompromised patients. There have been recent developments in the treatment of AKs. At least one new topical drug has received approval for AK treatment. That topical preparation, like those on the market, must be used with finesse to avoid adverse reactions. Similarly, whereas some of the destructive therapies used for AKs have been around for decades, others are more recent. Dermatologists need information on the variety of ways these topical and destructive treatments can be used, either alone or in combination, in order to accomplish successful long-term eradication of AKs, BCCs and SCCs.

Verruca vulgaris, or warts, occur commonly on the face, hands, and feet of adults and children. The viruses that cause these warts have little if any malignant potential. However, the American Academy of Dermatology has issued guidelines for their removal, which reflect patient wishes, fear of the warts spreading, disfigurement, and symptoms such as pain and itching. Pain issues make treatment of warts in children with cryotherapy or laser more difficult than it is in adults. Dermatologists need information on the relatively painless topical treatments that are available to use for wart removal in children.

Learning Objectives

By reading and studying this supplement, participants should be able to:

• Summarize the modalities currently available for the treatment of AK, and list the major advantages and disadvantages of each.

• Discuss the balance between treatment efficacy and duration of topical therapy as well as the trade-offs between patient compliance and treatment tolerability.

• Discuss the risk for metastatic SCC in patients with actinic cheilitis or who are immunocompromised.

• Describe the issues that guide the choice of therapy for treatment of warts in children and discuss which therapies are preferred for treating this age group.

CME Recognition

The Skin & Allergy News supplement, “Clinical Dialogues: Actinic Keratosis and Other Nonmelanoma Skin Cancers” is recognized by the American Academy of Dermatology for 1 hour of AAD Category 1 credit and may be used toward the American Academy of Dermatology's Continuing Medical Education Award.

This program was developed in accordance with the Accreditation Council for Continuing Medical Education guidelines.

Term of approval: June 2004-May 2005.

Copyright © 2004 by International Medical News Group

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