PMC5892259_01
Complete and sustained remission of extensive hydroxycarbamide-associated skin carcinogenesis fields after switching to anagrelide: exemplary presentation of the alterations on the balding scalp skin. (a) At presentation numerous, confluent, hypertrophic actinic keratoses cover almost the entire scalp. Removal of the hyperkeratosis revealed an oozing erosion (arrow). (b) A significant load of actinic keratoses persists 3 months after onset of treatment with cryosurgery plus ingenol mebutate (7 treatment cycles) and daily 0.32 mg/kg b.w. acitretin. At that point acitretin dose was doubled (0.64 mg/kg b.w./d) and the patient was switched from hydroxycarbamide to anagrelide. (c) Impressive improvement after one month in the last treatment scheme (anagrelide and acitretin, no topical treatments). (d) Sustainable "clearance" of the field 20 months after discontinuation of acitretin and still on anagrelide: complete regression of existing and no development of new actinic keratoses.
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The majority of the lesions, especially on the scalp, were covered by a hyperkeratotic crust that could be removed relatively easy, revealing an oozing erosion (Figure 1(a)). AK load had only marginally improved (Figure 1(b)). Already within a month after the latter treatment adaptation an impressive regression of the AK load was evident (Figure 1(c)). At the 3-month follow-up, complete AK remission was recorded and acitretin was discontinued. To date, 20 months later, no new AKs have developed (Figure 1(d)) and as we could not identify any clinical signs of AK to sample, a confirmatory biopsy was not performed (Figure 1(d)).
PMC5892259_02