RISK FACTORS: Equatorial latitudes, High elevations, Outdoor occupation (farmers, sailors, ranchers), Outdoor athletics, Sun worshippers, Accompanying heat, wind, humidity augment carcinogenic effect, Occupational exposure, i.e., petroleum products
GENERAL MEASURES Sun-protective techniques (See Patient Education)
SURGICAL MEASURES
. Cryosurgery for smaller number of lesions
. For extensive lesions (but medical treatment usually preferred)
. Skin peels, i.e., 35% trichloroacetic acid
. CO2 laser therapy
. Dermabrasion
DRUG(S) OF CHOICE Topical fluorouracil (Efudex, Carac, Fluoroplex cream, Fluoroplex solution) destroys even subclinical lesions, also non-scarring; usually applied bid for 3-4 weeks (for larger number of lesions)
ALTERNATIVE DRUGS
β’ Topical tretinoin (Retin-A) or tazarotene (Tazorac) may be used to enhance the effi cacy of topical fluorouracil
β’ Photodynamic therapy with aminolevulinic acid and blue light
β’ 3% diclofenac (Solaraze) gel bid for 3 months
β’ Topical imiquimod (Aldara) 5% cream, an interferoninducer. Apply twice weekly for 16 weeks to small (<25
square cm) areas of involvement
PATIENT MONITORING Dependent on associated malignancy and frequency with which new
actinic keratoses appear
PREVENTION/AVOIDANCE Sun protective techniques (See Patient Education)
POSSIBLE COMPLICATIONS Actinic keratosis is a premalignant lesion and may undergo carcinomatous proliferation to become squamous cell carcinoma
EXPECTED COURSE/PROGNOSIS Excellent, if prevention taken by patient