{"id":382287,"global_id":"medizinonline.com\/fr\/?id=382287","global_id_lineage":["medizinonline.com\/fr\/?id=382287"],"author":"17458","status":"publish","date":"2024-03-19 17:08:53","date_utc":"2024-03-19 16:08:53","modified":"2024-03-19 17:08:53","modified_utc":"2024-03-19 16:08:53","url":"https:\/\/medizinonline.com\/fr\/event\/workshop-icd-11-und-indikatorenrechtsprechung-online\/","rest_url":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/events\/382287","title":"Workshop ICD-11 und Indikatorenrechtsprechung – ONLINE","description":"","excerpt":"","slug":"workshop-icd-11-und-indikatorenrechtsprechung-online","image":false,"all_day":true,"start_date":"2024-05-24 00:00:00","start_date_details":{"year":"2024","month":"05","day":"24","hour":"00","minutes":"00","seconds":"00"},"end_date":"2024-05-24 23:59:59","end_date_details":{"year":"2024","month":"05","day":"24","hour":"23","minutes":"59","seconds":"59"},"utc_start_date":"2024-05-23 22:00:00","utc_start_date_details":{"year":"2024","month":"05","day":"23","hour":"22","minutes":"00","seconds":"00"},"utc_end_date":"2024-05-24 21:59:59","utc_end_date_details":{"year":"2024","month":"05","day":"24","hour":"21","minutes":"59","seconds":"59"},"timezone":"Europe\/Zurich","timezone_abbr":"CEST","cost":"","cost_details":{"currency_symbol":"","currency_code":"","currency_position":"prefix","values":[]},"website":"","show_map":true,"show_map_link":true,"hide_from_listings":false,"sticky":true,"featured":true,"categories":[{"name":"Arbeitsmedizin","slug":"arbeitsmedizin","term_group":0,"term_taxonomy_id":77253,"taxonomy":"tribe_events_cat","description":"","parent":0,"count":17,"filter":"raw","id":77253,"urls":{"self":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/categories\/77253","collection":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/categories"}},{"name":"General practice","slug":"general-practice","term_group":0,"term_taxonomy_id":90,"taxonomy":"tribe_events_cat","description":"","parent":0,"count":748,"filter":"raw","id":90,"urls":{"self":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/categories\/90","collection":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/categories"}}],"tags":[{"name":"Featured","slug":"featured","term_group":0,"term_taxonomy_id":77250,"taxonomy":"post_tag","description":"","parent":0,"count":351,"filter":"raw","id":77250,"urls":{"self":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/tags\/77250","collection":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/tags"}}],"venue":[],"organizer":[{"id":347406,"author":"4","status":"publish","date":"2013-09-18 00:00:00","date_utc":"2013-09-17 22:00:00","modified":"2013-09-18 00:00:00","modified_utc":"2013-09-17 22:00:00","url":"https:\/\/medizinonline.com\/fr\/15-a-20-des-lesions-peuvent-evoluer-vers-un-carcinome\/","organizer":"“15 \u00e0 20 % des l\u00e9sions peuvent \u00e9voluer vers un carcinome”.","description":"

Le professeur Stephan Lautenschlager, m\u00e9decin-chef du service de dermatologie de l’h\u00f4pital municipal de Triemli, nous donne des informations sur l’\u00e9pid\u00e9miologie, les m\u00e9thodes de diagnostic et le traitement de la k\u00e9ratose actinique. En outre, il aborde plus en d\u00e9tail la question de la dangerosit\u00e9 de cette maladie et du risque d’\u00e9volution vers un carcinome spinocellulaire malin.<\/strong><\/p>\n

<\/p>\n

Professeur Lautenschlager, la k\u00e9ratose actinique n’est pas encore consid\u00e9r\u00e9e comme un cancer de la peau, quelle est la dangerosit\u00e9 de cette maladie ?<\/strong><\/p>\n


\n Prof. Lautenschlager :<\/strong>
\n<\/em> On pense aujourd’hui que les k\u00e9ratoses actiniques font partie d’un continuum de maladies initi\u00e9es par l’exposition aux UV. Il s’agit d’abord d’un dommage lumineux d\u00fb aux UV, puis de la formation de k\u00e9ratoses actiniques, qui peuvent \u00e0 leur tour \u00e9voluer vers un carcinome \u00e9pidermo\u00efde. En raison des modifications cytologiques limit\u00e9es \u00e0 l’\u00e9pith\u00e9lium, les k\u00e9ratoses actiniques sont consid\u00e9r\u00e9es comme des carcinomes in situ selon la doctrine actuelle. <\/p>\n

Quelle est la pr\u00e9valence de la k\u00e9ratose actinique et quels sont les groupes de population les plus touch\u00e9s ?<\/strong><\/p>\n

Il est bien connu que les individus ayant une peau claire et complexe ont tendance \u00e0 d\u00e9velopper des k\u00e9ratoses actiniques dans les zones o\u00f9 l’exposition aux UV est \u00e9lev\u00e9e. Ainsi, on les trouve chez environ 50% des adultes en Australie, contre 10 \u00e0 25% sous nos latitudes. Les personnes \u00e2g\u00e9es de plus de 70 ans semblent pr\u00e9senter des pr\u00e9valences encore plus \u00e9lev\u00e9es. Auparavant, les hommes \u00e9taient plus souvent touch\u00e9s que les femmes en raison d’une exposition professionnelle. Cependant, ce rapport s’est \u00e9quilibr\u00e9 au cours des 10 \u00e0 20 derni\u00e8res ann\u00e9es en raison de l’augmentation de l’exposition aux UV li\u00e9e aux loisirs.<\/p>\n

Quel est le risque de d\u00e9velopper un carcinome malin (spinocellulaire) si l’on souffre d\u00e9j\u00e0 de k\u00e9ratose actinique ? Les chiffres issus de la recherche semblent varier consid\u00e9rablement \u00e0 cet \u00e9gard<\/strong><\/p>\n

Les k\u00e9ratoses actiniques peuvent rester stables pendant des ann\u00e9es, dispara\u00eetre en partie spontan\u00e9ment ou justement se transformer en carcinomes spinocellulaires. Malheureusement, il n’est pas possible de pr\u00e9dire le moment de la transformation en carcinome invasif ni les formes qui y sont sujettes. On estime que 15 \u00e0 20 % des l\u00e9sions \u00e9voluent vers un carcinome dans les dix ans.<\/p>\n

Quelles m\u00e9thodes les m\u00e9decins doivent-ils utiliser pour diagnostiquer la k\u00e9ratose actinique ?<\/strong><\/p>\n

En principe, le diagnostic est clinique, mais il peut exister diff\u00e9rentes formes, qui se pr\u00e9sentent ensuite diff\u00e9remment sur le plan histologique, par exemple des k\u00e9ratoses lich\u00e9no\u00efdes, boweno\u00efdes, pigment\u00e9es et atrophiques jusqu’aux k\u00e9ratoses hypertrophiques de type cornu cutaneum. En particulier, les k\u00e9ratoses \u00e9paissies – dites infiltr\u00e9es – doivent faire l’objet d’une biopsie pour exclure une invasion et donc un carcinome spinocellulaire. Dans les mains d’une personne exp\u00e9riment\u00e9e, une \u00e9valuation au microscope \u00e0 lumi\u00e8re r\u00e9fl\u00e9chie peut en outre s’av\u00e9rer utile.<\/p>\n

Est-il possible d’\u00e9tablir une distinction diagnostique claire entre la k\u00e9ratose actinique et le carcinome spinocellulaire ?<\/strong><\/p>\n

Seul un \u00e9paississement indique la possibilit\u00e9 d’un carcinome spinocellulaire.
\nEn cas de doute, il convient donc toujours de proc\u00e9der \u00e0 une \u00e9valuation histologique. En outre, il convient de noter que l’histologie de l’\u00e9piderme ne permet pas de distinguer une k\u00e9ratose actinique d’un carcinome spinocellulaire et que la biopsie doit donc \u00eatre suffisamment profonde.<\/p>\n

Quelles autres maladies doivent faire l’objet d’une attention particuli\u00e8re dans le diagnostic diff\u00e9rentiel ?<\/strong><\/p>\n

Si, plus rarement, une seule modification doit \u00eatre d\u00e9limit\u00e9e, il faut distinguer les k\u00e9ratoses s\u00e9borrh\u00e9iques planes l\u00e9g\u00e8rement pigment\u00e9es ou, le cas \u00e9ch\u00e9ant, les modifications induites par un virus, les carcinomes basocellulaires superficiels ou une maladie de Bowen. Plus rarement, il faut d\u00e9limiter les modifications purement inflammatoires, comme le lupus \u00e9ryth\u00e9mateux disco\u00efde.<\/p>\n

Il existe une possibilit\u00e9 de r\u00e9gression spontan\u00e9e. Des mesures th\u00e9rapeutiques sont-elles recommand\u00e9es ?<\/strong><\/p>\n

D’une part, il existe souvent de multiples k\u00e9ratoses actiniques, qui indiquent ce que l’on appelle une carcinose de terrain. Celle-ci multiplie le risque de transformation en carcinome spinocellulaire. D’autre part, les l\u00e9sions progressives ne peuvent pas \u00eatre distingu\u00e9es des l\u00e9sions r\u00e9gressives, c’est pourquoi il existe un consensus parmi les experts pour traiter les k\u00e9ratoses actiniques. Cependant, il n’existe pas encore de consensus sur les mesures th\u00e9rapeutiques \u00e0 prendre pour obtenir le meilleur r\u00e9sultat dans telle ou telle situation.<\/p>\n

Quelles sont les options th\u00e9rapeutiques m\u00e9dicamenteuses ? Laquelle vous semble la plus efficace ?<\/strong><\/p>\n

Il existe de nombreuses possibilit\u00e9s de traitement. La d\u00e9cision doit \u00eatre prise en fonction du nombre, de la localisation, du type de peau ainsi que d’autres particularit\u00e9s individuelles du patient. Outre la situation de vie, les comorbidit\u00e9s, l’observance et les pr\u00e9f\u00e9rences des patients doivent \u00e9galement \u00eatre prises en compte. Enfin, l’exp\u00e9rience et la familiarit\u00e9 des m\u00e9decins traitants jouent \u00e9galement un r\u00f4le d\u00e9cisif.
\nLa cryoth\u00e9rapie est un traitement largement r\u00e9pandu et efficace pour les formes plus isol\u00e9es. Si l’objectif est de traiter la carcinogen\u00e8se de terrain afin de traiter si possible les l\u00e9sions d\u00e9butantes, non encore visibles, la pr\u00e9f\u00e9rence doit \u00eatre donn\u00e9e \u00e0 la th\u00e9rapie photodynamique ainsi qu’au traitement local par imiquimod, fluorouracile topique ou \u00e9ventuellement diclof\u00e9nac aux stades pr\u00e9coces. Un nouveau traitement topique prometteur \u00e0 base de gel de m\u00e9butate d’ing\u00e9nol a r\u00e9cemment \u00e9t\u00e9 approuv\u00e9 en Suisse. On peut supposer que l’utilisation du traitement pendant une courte p\u00e9riode seulement am\u00e9liore nettement l’observance du patient. Pour les cas \u00e9tendus, en particulier lorsque le scalp entier est atteint chez les patients \u00e2g\u00e9s, il faut \u00e9galement penser \u00e0 la possibilit\u00e9 d’un traitement par rayons X, qui entra\u00eene g\u00e9n\u00e9ralement une longue p\u00e9riode de r\u00e9mission, mais n\u00e9cessite g\u00e9n\u00e9ralement six cycles de traitement.<\/p>\n

Quels conseils les m\u00e9decins doivent-ils donner \u00e0 leurs patients en cas de k\u00e9ratose actinique ?<\/strong><\/p>\n

Outre l’information sur les signes d’alerte d’un d\u00e9but de transformation en carcinome spinocellulaire, les patients doivent recevoir des instructions pr\u00e9cises sur les mesures de protection solaire. En plus d’une protection solaire textile, la plus grande priorit\u00e9 est l’application r\u00e9guli\u00e8re de produits solaires avec un facteur de protection solaire \u00e9lev\u00e9 \u00e0 tr\u00e8s \u00e9lev\u00e9. Bien entendu, les solariums sont \u00e9galement \u00e0 \u00e9viter.<\/p>\n

Entretien : Andreas Grossmann<\/strong><\/em><\/p>","slug":"15-a-20-des-lesions-peuvent-evoluer-vers-un-carcinome","image":{"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631.jpg","id":33988,"extension":"jpg","width":767,"height":294,"filesize":84660,"sizes":{"thumbnail":{"width":320,"height":240,"mime-type":"image\/jpeg","filesize":8207,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-320x240.jpg"},"cnvs-small":{"width":80,"height":80,"mime-type":"image\/jpeg","filesize":1865,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-80x80.jpg"},"cnvs-thumbnail":{"width":300,"height":225,"mime-type":"image\/jpeg","filesize":7799,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-300x225.jpg"},"pk-small":{"width":80,"height":80,"mime-type":"image\/jpeg","filesize":1865,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-80x80.jpg"},"pk-thumbnail":{"width":300,"height":225,"mime-type":"image\/jpeg","filesize":7799,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-300x225.jpg"},"csco-120":{"width":120,"height":46,"mime-type":"image\/jpeg","filesize":1915,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-120x46.jpg"},"csco-120-landscape":{"width":120,"height":90,"mime-type":"image\/jpeg","filesize":2611,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-120x90.jpg"},"csco-120-portrait":{"width":120,"height":160,"mime-type":"image\/jpeg","filesize":3163,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-120x160.jpg"},"csco-120-square":{"width":120,"height":120,"mime-type":"image\/jpeg","filesize":2809,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-120x120.jpg"},"csco-90":{"width":90,"height":34,"mime-type":"image\/jpeg","filesize":1567,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-90x34.jpg"},"csco-90-landscape":{"width":90,"height":68,"mime-type":"image\/jpeg","filesize":2008,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-90x68.jpg"},"csco-90-portrait":{"width":90,"height":120,"mime-type":"image\/jpeg","filesize":2372,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-90x120.jpg"},"csco-90-square":{"width":90,"height":90,"mime-type":"image\/jpeg","filesize":2190,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-90x90.jpg"},"csco-320":{"width":320,"height":123,"mime-type":"image\/jpeg","filesize":6207,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-320x123.jpg"},"csco-320-landscape":{"width":320,"height":240,"mime-type":"image\/jpeg","filesize":8207,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-320x240.jpg"},"csco-320-portrait":{"width":320,"height":294,"mime-type":"image\/jpeg","filesize":9495,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-320x294.jpg"},"csco-320-square":{"width":320,"height":294,"mime-type":"image\/jpeg","filesize":9495,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-320x294.jpg"},"csco-560":{"width":560,"height":215,"mime-type":"image\/jpeg","filesize":12835,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-560x215.jpg"},"csco-560-landscape":{"width":560,"height":294,"mime-type":"image\/jpeg","filesize":16820,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-560x294.jpg"},"csco-560-portrait":{"width":560,"height":294,"mime-type":"image\/jpeg","filesize":16820,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-560x294.jpg"},"csco-560-square":{"width":560,"height":294,"mime-type":"image\/jpeg","filesize":16820,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-560x294.jpg"},"cnvs-small-2x":{"width":160,"height":160,"mime-type":"image\/jpeg","filesize":3911,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-160x160.jpg"},"cnvs-thumbnail-2x":{"width":600,"height":294,"mime-type":"image\/jpeg","filesize":17972,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-600x294.jpg"},"pk-small-2x":{"width":160,"height":160,"mime-type":"image\/jpeg","filesize":3911,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-160x160.jpg"},"pk-thumbnail-2x":{"width":600,"height":294,"mime-type":"image\/jpeg","filesize":17972,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-600x294.jpg"},"csco-120-2x":{"width":240,"height":92,"mime-type":"image\/jpeg","filesize":4201,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-240x92.jpg"},"csco-120-landscape-2x":{"width":240,"height":180,"mime-type":"image\/jpeg","filesize":5818,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-240x180.jpg"},"csco-120-portrait-2x":{"width":240,"height":294,"mime-type":"image\/jpeg","filesize":7176,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-240x294.jpg"},"csco-120-square-2x":{"width":240,"height":240,"mime-type":"image\/jpeg","filesize":6286,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-240x240.jpg"},"csco-90-2x":{"width":180,"height":69,"mime-type":"image\/jpeg","filesize":3055,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-180x69.jpg"},"csco-90-landscape-2x":{"width":180,"height":136,"mime-type":"image\/jpeg","filesize":4172,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-180x136.jpg"},"csco-90-portrait-2x":{"width":180,"height":240,"mime-type":"image\/jpeg","filesize":5054,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-180x240.jpg"},"csco-90-square-2x":{"width":180,"height":180,"mime-type":"image\/jpeg","filesize":4630,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-180x180.jpg"},"csco-320-2x":{"width":640,"height":245,"mime-type":"image\/jpeg","filesize":15488,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-640x245.jpg"},"csco-320-landscape-2x":{"width":640,"height":294,"mime-type":"image\/jpeg","filesize":18698,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-640x294.jpg"},"csco-320-portrait-2x":{"width":640,"height":294,"mime-type":"image\/jpeg","filesize":18698,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-640x294.jpg"},"csco-320-square-2x":{"width":640,"height":294,"mime-type":"image\/jpeg","filesize":18698,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-640x294.jpg"},"thumbnail-2x":{"width":640,"height":294,"mime-type":"image\/jpeg","filesize":18698,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-640x294.jpg"}}},"json_ld":{"@type":"Person","name":"“15 \u00e0 20 % des l\u00e9sions peuvent \u00e9voluer vers un carcinome”.","description":"<p>Le professeur Stephan Lautenschlager, m\u00e9decin-chef du service de dermatologie de l\\'h\u00f4pital municipal de Triemli, nous donne des informations sur l\\'\u00e9pid\u00e9miologie, les m\u00e9thodes de diagnostic et le traitement de la k\u00e9ratose…<\/p>\\n","image":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631.jpg","url":"","telephone":"","email":"","sameAs":""},"global_id":"medizinonline.com\/fr\/?id=347406","global_id_lineage":["medizinonline.com\/fr\/?id=347406"]}],"custom_fields":[],"json_ld":{"@context":"http:\/\/schema.org","@type":"Event","name":"Workshop ICD-11 und Indikatorenrechtsprechung – ONLINE","description":"","url":"https:\/\/medizinonline.com\/fr\/event\/workshop-icd-11-und-indikatorenrechtsprechung-online\/","eventAttendanceMode":"https:\/\/schema.org\/OfflineEventAttendanceMode","eventStatus":"https:\/\/schema.org\/EventScheduled","startDate":"2024-05-24T00:00:00+02:00","endDate":"2024-05-24T23:59:59+02:00","organizer":{"@type":"Person","name":"“15 \u00e0 20 % des l\u00e9sions peuvent \u00e9voluer vers un carcinome”.","description":"<p>Le professeur Stephan Lautenschlager, m\u00e9decin-chef du service de dermatologie de l\\'h\u00f4pital municipal de Triemli, nous donne des informations sur l\\'\u00e9pid\u00e9miologie, les m\u00e9thodes de diagnostic et le traitement de la k\u00e9ratose…<\/p>\\n","image":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631.jpg","url":"","telephone":"","email":"","sameAs":""},"performer":"Organization"}}