Management Pearls on the Treatment of Actinic Keratoses and Field Cancerization

Abstract

Field cancerization (FC) is a chronic disease involving multiple clinical and subclinical actinic keratoses (AK) on large photo-exposed surfaces with multifocal areas of dysplasia and precancerous changes. Patients and treatment must be properly monitored and managed to avoid aggravation and progression of the disease. Management of actinic keratoses includes lesion-directed treatments, such as cryotherapy and field-directed therapies. Field-directed therapies may have the potential to address subclinical damage, reduce AK recurrence rates and potentially reduce the risk of squamous cell carcinoma development. Multiple studies have demonstrated the efficacy of field-directed treatments, including 5-fluorouracil, photodynamic therapy, imiquimod, chemical exfoliation with trichloroacetic acid and diclofenac gel, for multiple AK and FC. The choice of therapy should be based on multiple factors, such as efficacy, tolerability, patient risk profile, costs and cosmetic results. Management of AK includes not only treatment but also prevention. Medical devices, such as sunscreens containing liposome-encapsulated DNA repair enzymes, can repair DNA damage associated with chronic UV radiation and reduce the number of new AK lesions. Here we provide therapeutic pearls and expert opinions on the treatment of AK and FC (as monotherapy or in combination) with the overall aim to achieve better, faster, and well-tolerated clinical responses.

Urea in Dermatology: A Review of its Emollient, Moisturizing, Keratolytic, Skin Barrier Enhancing and Antimicrobial Properties

“…Treatment of hyperkeratotic actinic keratoses can be challenging. Pretreatment with keratolytics such as urea-based formulations at high concentration (40%), salicylic acid or topical retinoids can increase response rates [45].…”

UV Protection in the Cornea: Failure and Rescue

“…Certainly, with regards to skin, liposomal T4N5 delivery has had beneficial effects on CPD repair [ 208 ]. This has led to the design and distribution of T4N5-containing pharmaceutical products as a protective option for particularly photo-vulnerable patients [ 209 ]. The use of photolyase in such products presents a possible continuation of the effort to include not just protective measures but also repairing elements in UV screens.…”

Topical Photodynamic Therapy with Different Forms of 5-Aminolevulinic Acid in the Treatment of Actinic Keratosis

“…PDT is a hardly invasive method, is generally well tolerated, is repeatable [9] and is applied either directly onto the lesion or onto the entire field of cancerization [4]. (Figure 1) PDT has been shown to eliminate AK lesions and prevent their recurrence [8,10]. The action of PDT is based on selective photooxidation of the lesional tissue with the simultaneous involvement of three indispensable components, i.e., a PS, oxygen, and light of appropriate wavelength.…”