P1974 - Active Prevention of Keratinocyte Carcinomas in Europe: Therapeutic Choices and Decision-Making Rationales

Introduction The global incidence of keratinocyte carcinomas (KCs) is consistently rising. While consensus-based guidelines for active chemoprevention exist (recommending modalities like oral acitretin, nicotinamide, and photodynamic therapy), their real-world adoption and the rationales driving European dermatologists' therapeutic choices remain largely unclear. The objectives of the study were to evaluate the real-world adoption rates, therapeutic preferences, and underlying decision-making rationales of European dermatologists regarding the active prevention of KCs. Materials and Methods A web-based survey was distributed to 9,469 active European dermatologists. The survey assessed the frequency of preventive practices, treatment rankings, and the importance of various rationales (e.g., scientific evidence, familiarity, legal status, affordability) for both adopting and rejecting specific methods. Results Data from 1,274 respondents for primary prevention and 517 for secondary prevention (20.1% response rate) were analysed. Approximately 25% of practitioners seldom or almost never offer active prevention, with significant inter-country variability (p < 0.001). Topical imiquimod emerged as the most popular preventive method, significantly outpacing guideline-endorsed systemic options. "Scientific evidence" was the primary rationale for adopting a therapy, whereas "lack of familiarity" was the leading reason for rejection, particularly concerning oral nicotinamide. Lack of access and off-label legal status acted as major deterrents, while potential profitability was the least significant decision factor. The diagnosis of a previous KC increased the willingness to engage in prevention but did not alter the underlying rationale for method selection. Conclusions There is a significant discrepancy between current KC chemoprevention guidelines and everyday clinical practice among European dermatologists. A widespread preference for topical field therapies over systemic agents highlights a prevalent "systemic therapy hesitancy". To optimize healthcare resources and effectively change clinical behaviour efforts must go beyond raising awareness; they must focus on revising educational curricula, improving drug accessibility, and clarifying labelling regulations.