Optimum treatment strategies for actinic keratosis (intraepidermal squamous cell carcinoma)

Actinic keratoses are superficial squamous cell carcinomas. Treatment of these lesions is indicated to prevent the cells from invading the dermis and possibly metastasizing. If a lesion exhibits evidence of possible dermal invasion, such as marked erythema, ulceration, tenderness, bleeding, and especially induration, the physician should always consider performing a biopsy. Cryosurgical destruction, the most common treatment employed, has been shown to be 98.8% effective in eliminating the lesions. Adverse reactions such as scarring, textural changes, infection, and pigmentation alteration rarely occur. Physical destruction using electrodesiccation and curettage is particularly effective when the patient has hyperkeratotic lesions. When a patient has a multitude of actinic keratoses, the use of other treatments including fluorouracil, nonsteroidal anti-inflammatory preparations, immune response modifiers, and photodynamic therapy should be considered. However, none of these treatments has proven to be as effective overall as cryosurgical destruction. If a lesion does not respond to treatment, obtaining a biopsy of the lesion should be considered to be certain that the lesion is not an invasive squamous cell carcinoma.