Oshyvalova O. Clinical and Pathogenetic, Medical and Social Rationale for Improving Secondary Prevention of Actinic Keratosis

The thesis is aimed at solving the current scientific and practical problem of increasing the efficacy of secondary prevention of actinic keratosis by medical and social, clinical and pathogenetic substantiation and the development of functional-organizational model for its improvement. The information base of the study consisted of the results of our own research, which involved a comprehensive retrospective analysis of the incidence of actinic keratosis, morbidity and mortality rate due to squamous cell skin cancer in Ukraine; the study of the prevalence of risk factors for skin cancer; the analysis of the current state of secondary prevention of actinic keratosis; the assessment of the level of professional competence of dermatovenerologists, the study of the professional opinion of doctors and health care organizers regarding the level of training of medical workers and organizational approaches to improving the secondary prevention of actinic keratosis. Clinical and histological, molecular and genetic, immunohistochemical study enabled to substantiate, develop and implement an algorithm for making clinical decisions on the choice of diagnostic, therapeutic and preventive measures, which became the basic element of the local protocol of medical assistance for patients with actinic keratosis. For the first time in Ukraine, the thesis research allowed us to scientifically substantiate and develop a functional-organizational model for improving secondary prevention of actinic keratosis; to develop a local protocol of medical assistance for patients with actinic keratosis; to propose a mathematical prognostic model for determining individual risk of skin cancer; to determine the negative influence of actinic keratosis on patients’ life quality; to identify the association of malignant transformation of various degrees of invasiveness with L-myc gene determinism and the modifying effect of TNFα and Tp53 gene variants on pathological transformation in the AK focus, as well as those depending on the level of epithelial dysplasia; to reveal the affinity of molecular genetic changes in the foci of actinic keratosis and squamous cell skin cancer; to prove the expediency of using a radiosurgical method for patients with actinic keratosis as a medical technology for secondary prevention. There were further developed such issues as the study of the life quality of patients with actinic keratosis and their satisfaction with medical care; the assessment by the medical community of professional training of medical staff on skin cancer prevention and clinical and organizational approaches to actinic keratosis prevention; the study of clinical and histological determinants of the disease depending on the level of epidermal dysplasia; the assessment of dermatoscopic features of actinic keratosis and the relationship between the vascular component of dermatoscopy and the level of epidermal dysplasia.