Cryosurgery shines for nonface, nonscalp actinic keratosis

Cryosurgery is a highly effective intervention against actinic keratosis (AK) in sites beyond the scalp and face, reports a new network meta-analysis (NMA).

Drawing from the databases of Medline, Embase, and the Cochrane library Central, the researchers identified 13 randomized controlled trials (RCTs) eligible for inclusion. Together, the trials yielded a pooled sample of 1,380 patients, in whom the efficacies of five treatment modalities were assessed: cryosurgery, ingenol mebutate, photodynamic therapy (PDT), colchicine, and 5-fluorouracil.

The NMA for participant complete clearance—defined as the percentage of patients who had all of their lesions cleared—included 10 trials. All interventions, aside from 5-fluorouracil, demonstrated significant superiority over placebo; cryosurgery achieved the greatest clearance rate (risk ratio [RR], 7.73, 95 percent confidence interval [CI], 3.21–18.61). It was followed by ingenol mebutate and PDT.

In terms of participant partial clearance, ingenol mebutate proved to be the best intervention (RR, 7.12, 95 percent CI, 4.36–11.64).

In subsequent analyses, cryosurgery (RR, 2.97, 95 percent CI, 2.45–3.59) and PDT (RR, 2.59, 95 percent CI 2.16–3.09) emerged as the most effective interventions regarding lesion clearance rate, defined as the proportion of lesions cleared after treatment.

Competing interventions analysis found that cryosurgery was the best intervention when efficacy was assessed by the participant complete clearance and lesion clearance rates, while ingenol mebutate ranked first in terms of partial clearance.

“We propose that the anatomical site is an important factor to consider for clinical decision-making and highlight the importance of a personalized approach for AK treatment. Future high-quality research must further evaluate interventions for AK located at sites other than the face or scalp and take into consideration the outcomes derived from the core outcome set for AK,” the researchers said.