Abstract
To discuss the terminology to define and classify actinic cheilitis (AC) and to build a consensus on the diagnostic and therapeutic approaches to AC. Two-round Delphi study using a questionnaire including 34 closed sentences (9 on terminology and taxonomy, 5 on potential for malignant transformation, 12 on diagnostic aspects, 8 on treatment) and 8 open questions. Experts' agreement was rated using a Likert scale (1-7). A consensus was reached on 24 out 34 statements (73.5%) and on 5 out of 8 (62.5%) close-ended questions. The response rate was identical in both rounds (attrition of 0%). AC is the term with the highest agreement (median of 7 (strongly agree; IQR: 6-7)) and the lowest dispersion (VC=21.33). 'Potentially malignant disorder' was the preferred classification group for AC (median of 7) and 85.6% of participants showing some level of agreement (CV<50). Experts (66.75%) consider AC a clinical term (median: 7; IQR: 4-7) and believe definitive diagnosis can be made clinically (median: 6; IQR: 5-7), particularly by inspection and palpation (median: 5; IQR: 4-6). Histopathological confirmation is mandatory for the management of AC (median: 5; IQR: 2.5-7), even for homogeneous lesions (median: 5; IQR: 3.5-6). Consensus was reached on all treatment statements (VC<50). AC is a potentially malignant disorder with a significant lack of agreement on diagnostic criteria, procedures, biopsy indications and the importance of techniques to assist in biopsy. A consensus was reached on nomenclature and management of this disorder.
Highlights
actinic cheilitis (AC) is a potentially malignant disorder with a significant lack of agreement on diagnostic criteria, procedures, biopsy indications and the importance of techniques to assist in biopsy
Actinic cheilosis and solar cheilitis have been discarded as inappropriate terms (CV >50)
Surgical approaches are better than non-surgical ones, and laser vaporization techniques could be used for multicentric or diffuse AC lesions with mild epithelial dysplasia
Summary
The term actinic cheilitis (AC) in scientific literature describes changes induced by chronic exposure to sunlight (ultraviolet A wavelength 320–400 nm and largely ultraviolet B wavelength 290– 320 nm) mostly affecting the lower lip.[1]. The current comprehension regarding AC clearly requires an effort to minimize disparities and reach agreements on terminological and taxonomical aspects, as well as in its diagnosis and treatment In this vein, an expert consensus (Delphi method) approach can support clinical decision-making, when evidence about a given topic is contradictory.[20] The Delphi method is aimed at structuring a consensus and it is based upon the anonymity of the experts among themselves and on the iteration with controlled feedback (experts are consulted more than once).21-26 This technique is a procedure for group communication meant to reach a convergence of opinion on a specific ‘real-world’ issue.[26]. The opinions of the experts were considered for non- consensual questions
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