The aim of IMPROVED is to develop core outcome sets for skin diseases and conditions that can be treated by pharmacologic as well as non-pharmacologic interventions, particularly procedures or surgery.   Each outcome set is a separate project and is based on the CSG-COUSIN roadmap, as well as methodologic guidance put forth by COMET.


Actinic keratosis (AK) is a ubiquitous early form of in situ cutaneous carcinogenesis.  AK is a precursor for cutaneous squamous cell carcinoma (SCC).  Treatment of AK should address both avoiding disease progression to invasive SCC, as well as symptoms of the AK, which can include pain, bleeding, and itch.  Diagnosis of AK is typically made based on history and physical examination.  Biopsy may be performed to rule out SCC, if appropriate.

A growing number of modalities can be used to treat AK.  Liquid nitrogen and other destructive modalities can target specific lesions.  So-called field treatment of larger affected skin areas can be performed by photodynamic therapy, as well as other topical agents, including chemo- and immunotherapies. 

A core outcomes set for AK would allow researchers to better understand the particular benefits and limitations of different treatments for this condition.   There is currently no consensus as to the most important outcomes to measure.  In view of the substantial direct medical costs of AK treatment, this may allow cost-saving, with cost shifting to therapies that allow better overall outcomes.