An elderly man with recurrent AK has 30 lesions on his sun-damaged head. How would you approach his problem?
The most likely therapy that a dermatologist would offer is cryotherapy since it is easy for the clinician, relatively well tolerated by the patient, and if the patient has medical insurance, inexpensive for the patient. However, only one study has quantified the efficacy of cryotherapy.
Therapies for which there is more substantial evidence are oral retinoids and topical 5-FU. However, the elderly patient may not tolerate the side-effects of these therapies. The clinician may then offer either topical retinoids or chemical peels. PDT and masoprocol, while likely to be beneficial according to the evidence, are not yet widely available. Similarly while intralesional interferon is likely to be beneficial, injection into the lesions is unlikely to be tolerated by the patient.
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