According to a report in the Archives of Dermatology, 3.7-million doctor visits occur each year in the United States for the management of actinic keratoses. Actinic keratosis results from sun damage of the skin and is considered precancerous for nonmelanoma skin cancers.

Among patients older than 40 years old, 331 squamous cell cancers will evolve for every 100,000 lesions of actinic keratoses.

For those who have multiple lesions, nearly 60 percent of these lesions will progress into squamous cell cancer.

Treatment generally involves freezing the actinic keratoses with liquid nitrogen. According to an oncology periodical, such treatment is expensive and not based on any published data.

Because AC is common and treatment is expensive, alternative and preventive strategies are needed.

At the Veterans Affairs Palo Alto Health Care Systems and Stanford University Medical Center, Dr. Basil M. Hantash, MD, PhD, studied the comparative efficacy of a carbon dioxide laser, a chemical peel using 30 percent trichloroacetic acid, or a cream with 5 percent fluorouracil against actinic keratoses and squamous cell carcinoma.

Patients were divided into three groups and each was assigned to one of the three treatment modalities listed above. All three groups of patients were followed every three months for at least two years.

At the end of three months, actinic keratoses lesions decreased by 83 percent in the fluorouracil group, by 89 percent in the acid group and by 92 percent in the laser group.

The risk of cancer was lowered in all three groups, especially the acid group, which achieved a 40-fold decrease in nonmelanoma skin cancers.

The researchers thought that trichloroacetic acid was superior to laser and fluorouracil cream based on the following: significant lowered risk of further actinic lesions and cancer, application in an outpatient setting, subjective measures of better tolerance and better compliance.

A review of this study by George J. Hurza, MD, clinical associate professor of dermatology and otolaryngology at St. Louis University School of Medicine, appeared in Journal Watch. He felt that the efficacy of fluorouracil cream was similar to that of acid and laser treatments and should be the clear choice given its greater cost effectiveness.

Whatever the results of a future larger study might show, at this time it is important to recognize that there are multiple, simple and effective treatments for actinic keratoses.

The decreased incidence of squamous cell carcinomas will spare the patients the morbidity and cost associated with aggressive surgical treatments.

V. Upender Rao, MD, FACP, practices at the Cancer and Blood Disease Center in Lecanto

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