The treatment of actinic keratoses

Background: Actinic keratoses are epidermal tumors that can develop into invasive squamous cell carcinoma. Recently, some Medicare carriers have limited reimbursement for destruction of actinic keratoses. Objective: We review treatments for actinic keratoses and the rationale for their use. Methods: Computerized literature searches were performed in MEDLINE. The search terms were "actinic keratoses" and "solar keratosis." Information from these searches was combined with considerable personal experience for the body of this work. Results: Many effective treatments for actinic keratoses exist. Cryosurgery and curettage are the most commonly used treatments. Cryosurgery is considered the standard of care for treatment of actinic keratoses. Topical 5-fluorouracil is used in 3.6% of cases and is rarely used alone on the first patient visit. Many other effective, less commonly used treatments are available. Conclusion: A physician should select the best treatment by considering features of the lesion(s) and the patient being treated. Ail actinic keratoses cannot be treated in the same manner. The failure to treat actinic keratoses may have serious consequences for the patient.