Destructive procedures are the standard of care for treatment of actinic keratoses

Facial Resurfacing for Nonmelanoma Skin Cancer Prophylaxis

“…The current standard of care for AKs involves routine skin surveillance followed by destruction of lesions with liquid nitrogen (LN 2 ) cryotherapy, often in conjunction with the topical application of fluorouracil. 7,8 Other recognized treatment modalities for AKs include but are not limited to trichloroacetic acid peel, curettage, electrosurgery, excision, dermabrasion, laser surgery, topical imiquimod, topical diclofenac sodium, and topical and systemic retinoids. [9][10][11] Several studies [12][13][14][15][16] have suggested that skin resurfacing using either a carbon dioxide laser or trichloroacetic acid chemical peel may provide prophylaxis against cutaneous malignancy.…”

“…20,24 Destructive procedures remain the standard treatment for AKs. 7 The most common modality involves cryotherapy with LN 2 , resulting in a depth-controlled tissue injury. However, despite an overreliance by dermatologists on LN 2 , there are, to our knowledge, no published studies that justify this expensive treatment modality as an efficient means to reduce the financial impact of AKs and NMSC on the health care system..…”

“…Some third-party payers have mandated that fluorouracil be used first, with localized freezing only for refractory lesions. 7 More recently, the novel immunomodulator imiquimod has been reported to be effective in the treatment of AKs. 25 In a study by Stockfleth et al, 25 patients with a 5-to 16-year history of recurrent AKs were treated thrice weekly with 5% imiquimod cream for 6 to 8 weeks.…”

The National Ambulatory Medical Care Survey: A resource for understanding the outpatient dermatology treatment

“…Studies reporting on outpatient dermatologic care have examined the utilization of dermatologists and other physicians for skin-related complaints, as well as the management of specific dermatologic diseases, and patterns of use of Including Asian, Native Hawaiian or other Pacific Islander, American Indian or Alaska Native, and more than one race reported. medications (8)(9)(10)(11)(12)(13)(14)(15). Identifying physicians' reported medical practices have aided in establishing community standards of care for common skin conditions (16).…”

“…For example, some Medicare carriers considered requiring treatment of actinic keratosis with 5-fluorouracil before destruction in order to qualify for reimbursement in the 1990s. Data from NAMCS observed no uses of 5-fluorouaracil alone at first visits for actinic keratoses, indicating that the initial use of 5-fluorouracil was not a standard of care for treatment of these lesions among the medical community (15). Data from NAMCS has also been used to determine and compare costs of care for dermatologic diseases such as psoriasis (17).…”