Premium
A feasibility study of microwave therapy for precancerous actinic keratosis
Author(s) -
Jackson D.N.,
Hogarth F.J.,
Sutherland D.,
Holmes E.M.,
Donnan P.T.,
Proby C.M.
Publication year - 2020
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.18935
Subject(s) - medicine , actinic keratosis , erythema , dermatology , randomized controlled trial , scalp , adverse effect , actinic keratoses , forehead , keratosis , basal cell , surgery
Summary Background Actinic keratosis ( AK ) is a common premalignant skin lesion that can progress to cutaneous squamous cell carcinoma ( cSCC ). Microwave therapy is an established cancer treatment and has been used for plantar viral warts. Objectives To evaluate the efficacy and feasibility of microwave as a treatment for AK . Methods Stage I was a dose‐setting study, in which seven participants had the dielectric properties of 12 thick and 22 thin AK s assessed for optimization of the microwave dose used for treatment in Stage II. Stage II was a randomized, internally controlled trial evaluating 179 AK s in 11 patients (93 treated, 86 untreated controls) on the scalp/forehead or dorsal hand. Participants received one treatment initially and a repeat treatment to unresolved AK s at week 4. The response was assessed at six visits over 4 months. The primary outcome was partial or complete resolution of the treated AK s. Results A significantly higher proportion of treated AK areas responded than untreated (90% vs. 15%; P < 0·001). Thin AK s were more responsive than thick AK s. The site did not affect efficacy. Pain was severe, but brief (80% reported pain lasting ‘a few seconds only’). Adverse effects were minimal (erythema, n = 6; flaking, n = 3; itch, n = 3). All participants who would chose microwave therapy over their current treatment cited the shorter discomfort period. Conclusions Microwave therapy is a portable, safe and effective treatment for AK . An easy‐to‐deliver, acceptable therapy for AK is attractive as a prevention strategy. While these results are promising, a larger randomized controlled trial is needed against an effective comparator to confirm clinical efficacy and patient acceptability.What is already known about this topic?Actinic keratoses (AKs) are common precancerous skin lesions. Successful treatment of AK can prevent cutaneous squamous cell carcinoma (cSCC). Most topical therapies for AK require repeated application over weeks and drive local skin inflammation, leading to poor compliance. An easy‐to‐deliver and effective treatment for AK, suitable for use in primary care, could reduce cSCC.What does this study add?Microwave therapy is a feasible, effective treatment for AK. Ninety per cent of treated AKs showed full or partial resolution at 120 days post‐treatment. Microwave therapy was painful, but the pain was short‐lived (seconds) and this short discomfort period was cited as the main reason that microwave was preferred to their current treatment.Linked Comment: Samimi and Kelleners-Smeets. Br J Dermatol 2020; 183:197–199.