Treatment of Actinic Keratoses Is More Than Cosmetic Issue

NEW YORK—Actinic keratoses should be treated or removed, according to the consensus of the American Academy of Dermatology, American Cancer Society, and Skin Cancer Foundation. “It is not merely a cosmetic issue,” said Jeffrey Callen, MD, chief of the Division of Dermatology, University of Louisville. Because of their potential to develop into skin cancer, these lesions should be regarded as a serious health problem, he said at a media briefing sponsored by the Academy as part of its Melanoma/Skin Cancer Detection and Prevention Month.

Dr. Callen said that p53 gene mutations present in actinic keratoses are similar to those found in squamous cell carcinoma. “Forty percent of squamous cell carcinomas begin as actinic keratoses, but most people do not seek treatment for these skin lesions,” he said.

He said that physicians need to raise awareness of the connection between actinic keratoses and squamous cell carcinoma and to treat the sun-induced scaly patches early.

“Although it is possible to diagnose an actinic keratosis on the basis of clinical appearance, it can be difficult to distinguish an actinic keratosis from a squamous cell carcinoma without a biopsy. Since some actinic keratoses will progress to squamous cell carcinoma, patients should see a dermatologist when they or their primary caregivers are in doubt,” Dr. Callen said.

Those at greatest risk for progression are the elderly and those with compromised immune systems, including people with HIV disease, organ transplant patients, and others on immunosuppressive therapies. As individuals in these risk groups live longer, their impaired immune surveillance may not handle actinic keratoses as effectively as those in whom the immune system is intact. Actinic keratoses may also be a marker for other cancers, Dr. Callen pointed out.

There is a wide selection of treatments available for actinic keratoses, ranging from destruction with liquid nitrogen and chemical or cryogenic peels; chemotherapy with such agents as fluorouracil, tretinoin, interferon, and calcitriol; and removal through curettage (with or without electrosurgery), dermabrasion, and lasers. A new treatment pending FDA approval involves photodynamic therapy.

Dr. Callen declined to recommend a particular therapy, stating that physician and patient must decide which is the most appropriate treatment for a given lesion. Location, number, and patient lifestyle are among factors to be considered.

Actinic keratoses are typically found on sun-exposed areas in older people, the result of cumulative sun exposure over many years. Sun avoidance and protection with sunscreens and protective clothing may prevent new lesions and delay progression to invasive disease, since UV radiation has been shown to impair immune surveillance, Dr. Callen said.