Risk Stratification: Should All Actinic Keratoses in All Patients Be Treated?

AbstractPurpose of ReviewActinic keratoses (AKs) are foci of dysplastic keratinocytes in the epidermis. They are markers of both photodamage and risk of keratinocyte carcinoma (KC) formation. Individual AKs are thought to progress to KC uncommonly, although they arise from the same UV-induced mutations which give rise to KC. Thus, the rationale for treatment of AKs is to reduce the risk of KC formation since AKs are not dangerous in themselves. An estimated $1.68 billion is spent on treatment of AKs in the United States annually. Treatment of a region of skin (e.g., face, scalp, or forearms) to clear AKs is termed field treatment. Though field treatment of AKs and actinic damage has been associated with a reduction in cutaneous squamous cell carcinoma (CSCC), it is unclear to what degree treatment of individual lesions positively impacts health.Recent FindingsThe presence of AKs has been correlated with formation of KC, particularly CSCC. Field treatment can be accomplished by topical therapy [photodynamic therapy (PDT), topical 5-fluorouracil, ingenol mebutate, imiquimod, and/or sunscreen] or oral systemic therapy including nicotinamide or retinoids (i.e., acitretin, isotretinoin). Field treatments have been associated with a reduction in KC and therefore are likely cost-effective. However, there is a lack of data showing that treatment of individual AK lesions (usually accomplished via cryotherapy) reduces KC. Although cryotherapy is only associated with a 4% sustained clea...
Source: Current Dermatology Reports - Category: Dermatology Source Type: research