Cryosurgery combined with topical interventions for actinic keratosis: A systematic review and meta‐analysis

Summary

Background

Actinic keratoses (AK) are early in situ carcinomas of the skin due to cumulative sun exposure. Cryosurgery is an easy and practicable lesion‐directed approach for isolated lesions.

Objectives

To investigate if an upfront combination of cryosurgery with a topical intervention is superior to cryosurgery alone for AK.

Methods

We performed a systematic literature research in Medline, Embase, and CENTRAL and hand‐searched pertinent trial registers for eligible randomized controlled trials until 17 July 2018. Results from individual studies were pooled using a random‐effects model. The risk of bias was estimated with the Cochrane Risk of Bias Tool and the quality of evidence of the outcomes with the GRADE approach.

Results

Out of 1,758 records initially identified, 9 studies with a sample size of 1,644 patients were included. Cryosurgery in combination with a topical approach showed significantly higher participant complete clearance rates compared to monotherapy (RR 1·74, 95% CI 1·25‐2·43, I²=73%, 8 studies. The participant partial clearance rate was not statistically different (RR 1·64, 95% CI 0·88‐3·03, I²=77%, 3 studies). The number of patients who completed the study protocol and did not withdraw due to adverse events was equal in both groups (RR 0·98, 95% CI 0·95‐1·01, I²=75%, 7 studies). The studies were estimated at high risk for selective reporting bias.

Conclusions

Our results suggest superiority of a combination regimen regarding AK clearance with equal tolerability. This study highlights the importance of a field‐directed approach in patients with multiple AK or field‐cancerization.

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