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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