Actinic keratoses are very common precancerous lesions of the skin. Up to 10% may progress to skin cancer usually, squamous cell carcinoma.

A few may become basal cell carcinoma. They do not progress to melanoma. Signs of progression include sensitivity and enlargement.

If only a few lesions are present, localized treatments may be used for significant lesions.

For more numerous lesions, field treatments may be used.

Localized treatments include:

  1. Freezing (cryosurgery) with Liquid Nitrogen
  2. Burning and scraping(curettage and desiccation) under a local anesthetic.

Field treatments include:

  1. 5-FU(Efudex or Carac) - topical chemotherapy which keeps cells from finishing cell division. Since, cells in actinic keratoses are dividing much more quickly then normal cells, they are selectively destroyed.
  2. Imiquimod (Aldara and Zyclara) - cream which increases the skins production of interferon, part of the immune system.
  3. Blue light treatment with Levulan - actinic keratoses take up more of the chemical, Levulan, than normal cells. Levulan sensitizes cells to the visible wavelength of light which is blue. When the Levulan treated skin is exposed to blue light, the actinic keratoses are selectively destroyed.
  4. Field modalities I have had less success with are diclofenac sodium (solaraze) and ingenol mebutate (picato).
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