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Actinic keratoses are small (0.2–0.6 cm) papules—flesh-colored, pink, or slightly hyperpigmented—that feel like sandpaper and are tender to palpation. They occur on sun-exposed parts of the body in persons of fair complexion. Actinic keratoses are considered premalignant; 1:1000 lesions per year progress to squamous cell carcinoma.

Application of liquid nitrogen provides rapid eradication of lesions, which crust and disappear in 10–14 days. “Field treatment” with a topical agent can be considered in patients with multiple lesions in one region (eg, forehead, dorsal hands, etc). Fluorouracil cream is the most effective topical agent used for field treatment; imiquimod, ingenol mebutate, and photodynamic therapy are also effective. Combination therapy may be clinically beneficial. Any lesions that persist should be evaluated for possible biopsy.

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Dianzani  C  et al. Current therapies for actinic keratosis. Int J Dermatol. 2020;59:677.
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Willenbrink  TJ  et al. Field cancerization: definition, epidemiology, risk factors, and outcomes. J Am Acad Dermatol. 2020;83:709.
[PubMed: 32387665]  

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