How Leading Practitioners are Treating AKs Today
February 2002
Y ou’ve seen actinic keratoses (AKs) time and time again, but how do you treat it? Are you still using the same treatment methods you used a decade ago, or have you branched out and tried some of the newer therapies? We asked a panel of skin care experts how they treat AKs in practice today. See what, if anything, you’re doing differently.
Meet the Experts
Now it’s time to meet our panel of experts.
Charles V. Perniciaro, M.D., of Jacksonville, FL, has been in practice for 14 years — all of which he spent in southern states. He thinks there are more cases of AKs today than there were a couple of decades ago and he contributes the increase to the fact that people are living longer and are engaging in more outdoor lifestyles.
Although for the last five years he hasn’t been treating AK patients frequently, Leo Indianer, M.D., of Encino, CA, did treat them regularly for 31 years before deciding to read slides for other dermatologists as a dermato-pathologist. His input for this article provides information from a different angle. He says it’s hard to say if there’s more cases these days because of the newer modalities of treatment that can bring out the AK without the need for biopsy — which is the side of it that he’s involved with now.
Twenty-four year AK veteran, Jeffrey P. Callen, M.D., of Louisville, KY, agrees with Dr. Perniciaro in that there are more cases of AKs today. “I see many more organ transplant recipients and my patients have aged as I’ve been in practice,” he states.
Darrell S. Rigel, M.D., of New York City, also thinks that there are more cases of AKs in practices today, but he offers a different reason: “Because there’s a 10- to 20-year delay of damage, we’re seeing today what damage people did in the 80s.” He adds that we may also see less in the next 10 or 20 years because of the delay factor and because patients are a little bit more aware of the condition. He also cites the fact that people are living longer, which may also add to why it seems the incidence of AKs have increased. Dr. Rigel has been in practice for 23 years.
Scott D. Glazer, M.D., of Chicago, who’s been in practice for 20 years, says that AK is probably a little more prevalent these days, but “it’s been fairly common throughout the years.”
Sandra K. Surbrugg, M.D., of Cheyenne, WY, who’s been in practice for 16 years, also says she’s seen an increase in the number of cases compared to a decade ago.
A profile of the AK patient
The practitioners we talked to see about the same amount of AK patients per day. Dr. Glazer says on an average day he sees about 10 AK patients, typically presenting as a light-skinned person with one or multiple red, scaly spots on his or her face — less commonly on the back of the hands and arms. Dr. Surbrugg also sees about 10 AK patients per day. Her patients are typically concerned about tender lesions on sun-exposed skin that aren’t healing.
Per day, Dr. Perniciaro sees about 15 who typically present with a crusted, slightly tender, small patch in a sun-exposed area. Dr. Indianer sees at least 20 patients per day microscopically. Recalling back to when he treated AK patients in his practice, he says that the typical patient presented with rough scaling on sun-damaged skin. The typical AK presentation Dr. Rigel encounters is severe sun damage on the several AK patients he sees per day.
Dr. Callen says the number of AK patients he sees in his office per day is variable — ranging from one to 15. “They typically present with a scaly, often irritated patch on an exposed surface.”
As you’re aware, AKs are known as the early beginnings of skin cancer. With this in mind, it makes sense to think that people would be more aware of the risk they take when they spend long hours in the sun without sunscreen. Some of the practitioners we spoke with agree with this thought; others disagree.
“People are more aware,” says Dr. Glazer. “There’s a lot of coverage in the media and people see that President Bush had AK and that President Clinton had basal cell carcinoma. Also, people see them because they’re on the skin. Sometimes patients are nervous about them and don’t like the way they look.”
He says he’s seeing a slightly younger population now, but that people are more aware of sunscreen and the use of it seems to be cutting down on problems. Dr. Surbrugg agrees that patients are more aware of skin cancer and AKs today.
Says Dr. Perniciaro, “Over the last 10 years, patients are much more aware of skin conditions. Many people just come in for a skin check — I can’t even remember 10 years ago that anyone would just come in to have me check their skin when they weren’t aware of a problem.”
Dr. Indianer, who, remember, works as a pathologist, has a different opinion of the patient aspect. He doesn’t think patients are more aware of AKs. “They’re still in denial,” he says.
Dr. Rigel and Dr. Callen are on the same side of the fence as Dr. Indianer. Says Dr. Rigel, “I don’t think many patients are concerned with the prevention of AKs — most of them don’t even know what AKs are. They are, however, concerned with skin damage and the effects of sun exposure on the aging process.”
Where They Stand on the Topic
There’s some different thinking about whether AKs are pre-malignant, malignant or neither. Some believe in a continuum theory, as does Dr. Perniciaro. He considers AKs to be pre-malignant “in a spectrum that leads to malignancy.” He explains that if you pick out an AK at any point of time, it could be malignant 6 weeks later.
Drs. Glazer, Callen, Rigel and Indianer all regard AKs as pre-malignant, though Dr. Rigel considers them pre-malignant to incipient malignant. Dr. Indianer regards the proliferative AK with extension along adnexal as an early type of malignancy, and this malignancy requires more careful follow-up.
Dr. Surbrugg, who agrees AKs are pre-malignant, says “the distinction is blurred both clinically and histologically between a hypertrophic AK and an SCC (squamous cell carcinoma).”
What are They Using?
So now come the questions you’ve all been waiting for:
l What therapies are these doctors using to treat AKs?
l What do they think of the newer methods?
l How do they select patients for treatment?
We’ll hear these experts’ answers to these questions.
Dr. Rigel’s gold standard therapy is cryotherapy, but he does a biopsy when he’s not sure if the area of skin is invasive. “I use a little bit of everything — photodynamic therapy (PDT) is useful for a whole area of multiple lesions and I use imiquimod (Aldara) topically for multiple lesions also.” He basically treats all patients and says that the big issue he faces is whether to biopsy them.
In 99% of cases, Dr. Perniciaro says he uses cryotherapy (liquid nitrogen in a pressurized container and squirted through a trigger). He only uses 5-fluorouricil sometimes and he’s tried imiquimod, but says it’s equivocal at best. “If a patient has diffuse, wide spread areas of damage where I can’t focus the trigger to spray the area, then they’re a candidate for the 5-fluorouricil, but I don’t use the other stuff (PDT and imiquimod),” says Dr. Perniciaro.
Dr. Surbrugg typically treats her patients with cryotherapy, using a Cryac, about every 3 to 6 months. She also treats two to three patients per day in her facility’s new PDT unit. She’s only been using it for 15 months, but says the response has been favorable, despite the fact that it’s a painful treatment. “The patients like the excellent cosmetic result with healing without hypopigmentation, unlike cryotherapy,” she explains. She selects patients by assessing the number, type and location of the lesions, and has found that hypertrophic lesions don’t respond as well to PDT.
Dr. Callen’s AK patients learn about cryotherapy because that’s what he uses on most of them. He says, “I reevaluate them 6 to 8 weeks after treatment and then I re-treat them if necessary. For patients who have multiple lesions, I may choose 5-fluorouricil or imiquimod or diclofenac sodium (Solaraze).” He has tried PDT, one of the newer methods of treating AKs. “We were part of a study for PDT, but I don’t think it’s practical for my office or for my patients,” he admits.
The gold standard of therapy for Dr. Glazer is 5-fluorouricil, but he says it all depends on the number of lesions a patient has. “If it’s something less than 10, then I use cryotherapy, but if there’s a lot of sun damage with AK, then I use Efudex, which is a 5% concentration of fluorouricil.”
Dr. Glazer tested PDT for the company and uses it on a limited basis — mainly for patients who have multiple lesions. He says, “Statistically, imiquimod has a better cure rate, but on the other hand, it causes more irritation, redness and discomfort.” He, like Dr. Surbrugg, selects patients for treatment by the number and location of their lesions. Generally he treats most lesions unless the patients is infirm or they have other health issues. “When I was younger, I used to treat all cases, but now I sometimes follow some of the cases. If the numbers are low, I’ll just freeze them — it works well and is effective and quick,” he says.
Feeling Out the New Terrain
You’ve probably realized that these practitioners don’t handle AK patients much differently than you do. However, it’s good to get a feel of what other professionals in your field are doing from time to time. These doctors are seeing quite a few AKs per day in their practice and it sounds as though they’re pretty much sticking to the tried-and-true methods they’ve come to trust over the years. But give it some more time, and the next time we revisit this topic, we just may see that many of these M.D.s, and others, have changed their tune and have started using the newer therapies more regularly.Actinic Keratoses. You’ve seen its victims before — the sun gods and goddesses who walk into your office radiating heat from years of accumulated sun exposure. Or maybe the fair-skinned patient who haplessly spent too many hours in the sun over the last few years. Whatever the patient’s physical appearance or leisure activities, the clinical presentations are always similar — rough, scaly skin; bumpy, mottled skin; or cutaneous horn.
Y ou’ve seen actinic keratoses (AKs) time and time again, but how do you treat it? Are you still using the same treatment methods you used a decade ago, or have you branched out and tried some of the newer therapies? We asked a panel of skin care experts how they treat AKs in practice today. See what, if anything, you’re doing differently.
Meet the Experts
Now it’s time to meet our panel of experts.
Charles V. Perniciaro, M.D., of Jacksonville, FL, has been in practice for 14 years — all of which he spent in southern states. He thinks there are more cases of AKs today than there were a couple of decades ago and he contributes the increase to the fact that people are living longer and are engaging in more outdoor lifestyles.
Although for the last five years he hasn’t been treating AK patients frequently, Leo Indianer, M.D., of Encino, CA, did treat them regularly for 31 years before deciding to read slides for other dermatologists as a dermato-pathologist. His input for this article provides information from a different angle. He says it’s hard to say if there’s more cases these days because of the newer modalities of treatment that can bring out the AK without the need for biopsy — which is the side of it that he’s involved with now.
Twenty-four year AK veteran, Jeffrey P. Callen, M.D., of Louisville, KY, agrees with Dr. Perniciaro in that there are more cases of AKs today. “I see many more organ transplant recipients and my patients have aged as I’ve been in practice,” he states.
Darrell S. Rigel, M.D., of New York City, also thinks that there are more cases of AKs in practices today, but he offers a different reason: “Because there’s a 10- to 20-year delay of damage, we’re seeing today what damage people did in the 80s.” He adds that we may also see less in the next 10 or 20 years because of the delay factor and because patients are a little bit more aware of the condition. He also cites the fact that people are living longer, which may also add to why it seems the incidence of AKs have increased. Dr. Rigel has been in practice for 23 years.
Scott D. Glazer, M.D., of Chicago, who’s been in practice for 20 years, says that AK is probably a little more prevalent these days, but “it’s been fairly common throughout the years.”
Sandra K. Surbrugg, M.D., of Cheyenne, WY, who’s been in practice for 16 years, also says she’s seen an increase in the number of cases compared to a decade ago.
A profile of the AK patient
The practitioners we talked to see about the same amount of AK patients per day. Dr. Glazer says on an average day he sees about 10 AK patients, typically presenting as a light-skinned person with one or multiple red, scaly spots on his or her face — less commonly on the back of the hands and arms. Dr. Surbrugg also sees about 10 AK patients per day. Her patients are typically concerned about tender lesions on sun-exposed skin that aren’t healing.
Per day, Dr. Perniciaro sees about 15 who typically present with a crusted, slightly tender, small patch in a sun-exposed area. Dr. Indianer sees at least 20 patients per day microscopically. Recalling back to when he treated AK patients in his practice, he says that the typical patient presented with rough scaling on sun-damaged skin. The typical AK presentation Dr. Rigel encounters is severe sun damage on the several AK patients he sees per day.
Dr. Callen says the number of AK patients he sees in his office per day is variable — ranging from one to 15. “They typically present with a scaly, often irritated patch on an exposed surface.”
As you’re aware, AKs are known as the early beginnings of skin cancer. With this in mind, it makes sense to think that people would be more aware of the risk they take when they spend long hours in the sun without sunscreen. Some of the practitioners we spoke with agree with this thought; others disagree.
“People are more aware,” says Dr. Glazer. “There’s a lot of coverage in the media and people see that President Bush had AK and that President Clinton had basal cell carcinoma. Also, people see them because they’re on the skin. Sometimes patients are nervous about them and don’t like the way they look.”
He says he’s seeing a slightly younger population now, but that people are more aware of sunscreen and the use of it seems to be cutting down on problems. Dr. Surbrugg agrees that patients are more aware of skin cancer and AKs today.
Says Dr. Perniciaro, “Over the last 10 years, patients are much more aware of skin conditions. Many people just come in for a skin check — I can’t even remember 10 years ago that anyone would just come in to have me check their skin when they weren’t aware of a problem.”
Dr. Indianer, who, remember, works as a pathologist, has a different opinion of the patient aspect. He doesn’t think patients are more aware of AKs. “They’re still in denial,” he says.
Dr. Rigel and Dr. Callen are on the same side of the fence as Dr. Indianer. Says Dr. Rigel, “I don’t think many patients are concerned with the prevention of AKs — most of them don’t even know what AKs are. They are, however, concerned with skin damage and the effects of sun exposure on the aging process.”
Where They Stand on the Topic
There’s some different thinking about whether AKs are pre-malignant, malignant or neither. Some believe in a continuum theory, as does Dr. Perniciaro. He considers AKs to be pre-malignant “in a spectrum that leads to malignancy.” He explains that if you pick out an AK at any point of time, it could be malignant 6 weeks later.
Drs. Glazer, Callen, Rigel and Indianer all regard AKs as pre-malignant, though Dr. Rigel considers them pre-malignant to incipient malignant. Dr. Indianer regards the proliferative AK with extension along adnexal as an early type of malignancy, and this malignancy requires more careful follow-up.
Dr. Surbrugg, who agrees AKs are pre-malignant, says “the distinction is blurred both clinically and histologically between a hypertrophic AK and an SCC (squamous cell carcinoma).”
What are They Using?
So now come the questions you’ve all been waiting for:
l What therapies are these doctors using to treat AKs?
l What do they think of the newer methods?
l How do they select patients for treatment?
We’ll hear these experts’ answers to these questions.
Dr. Rigel’s gold standard therapy is cryotherapy, but he does a biopsy when he’s not sure if the area of skin is invasive. “I use a little bit of everything — photodynamic therapy (PDT) is useful for a whole area of multiple lesions and I use imiquimod (Aldara) topically for multiple lesions also.” He basically treats all patients and says that the big issue he faces is whether to biopsy them.
In 99% of cases, Dr. Perniciaro says he uses cryotherapy (liquid nitrogen in a pressurized container and squirted through a trigger). He only uses 5-fluorouricil sometimes and he’s tried imiquimod, but says it’s equivocal at best. “If a patient has diffuse, wide spread areas of damage where I can’t focus the trigger to spray the area, then they’re a candidate for the 5-fluorouricil, but I don’t use the other stuff (PDT and imiquimod),” says Dr. Perniciaro.
Dr. Surbrugg typically treats her patients with cryotherapy, using a Cryac, about every 3 to 6 months. She also treats two to three patients per day in her facility’s new PDT unit. She’s only been using it for 15 months, but says the response has been favorable, despite the fact that it’s a painful treatment. “The patients like the excellent cosmetic result with healing without hypopigmentation, unlike cryotherapy,” she explains. She selects patients by assessing the number, type and location of the lesions, and has found that hypertrophic lesions don’t respond as well to PDT.
Dr. Callen’s AK patients learn about cryotherapy because that’s what he uses on most of them. He says, “I reevaluate them 6 to 8 weeks after treatment and then I re-treat them if necessary. For patients who have multiple lesions, I may choose 5-fluorouricil or imiquimod or diclofenac sodium (Solaraze).” He has tried PDT, one of the newer methods of treating AKs. “We were part of a study for PDT, but I don’t think it’s practical for my office or for my patients,” he admits.
The gold standard of therapy for Dr. Glazer is 5-fluorouricil, but he says it all depends on the number of lesions a patient has. “If it’s something less than 10, then I use cryotherapy, but if there’s a lot of sun damage with AK, then I use Efudex, which is a 5% concentration of fluorouricil.”
Dr. Glazer tested PDT for the company and uses it on a limited basis — mainly for patients who have multiple lesions. He says, “Statistically, imiquimod has a better cure rate, but on the other hand, it causes more irritation, redness and discomfort.” He, like Dr. Surbrugg, selects patients for treatment by the number and location of their lesions. Generally he treats most lesions unless the patients is infirm or they have other health issues. “When I was younger, I used to treat all cases, but now I sometimes follow some of the cases. If the numbers are low, I’ll just freeze them — it works well and is effective and quick,” he says.
Feeling Out the New Terrain
You’ve probably realized that these practitioners don’t handle AK patients much differently than you do. However, it’s good to get a feel of what other professionals in your field are doing from time to time. These doctors are seeing quite a few AKs per day in their practice and it sounds as though they’re pretty much sticking to the tried-and-true methods they’ve come to trust over the years. But give it some more time, and the next time we revisit this topic, we just may see that many of these M.D.s, and others, have changed their tune and have started using the newer therapies more regularly.Actinic Keratoses. You’ve seen its victims before — the sun gods and goddesses who walk into your office radiating heat from years of accumulated sun exposure. Or maybe the fair-skinned patient who haplessly spent too many hours in the sun over the last few years. Whatever the patient’s physical appearance or leisure activities, the clinical presentations are always similar — rough, scaly skin; bumpy, mottled skin; or cutaneous horn.
Y ou’ve seen actinic keratoses (AKs) time and time again, but how do you treat it? Are you still using the same treatment methods you used a decade ago, or have you branched out and tried some of the newer therapies? We asked a panel of skin care experts how they treat AKs in practice today. See what, if anything, you’re doing differently.
Meet the Experts
Now it’s time to meet our panel of experts.
Charles V. Perniciaro, M.D., of Jacksonville, FL, has been in practice for 14 years — all of which he spent in southern states. He thinks there are more cases of AKs today than there were a couple of decades ago and he contributes the increase to the fact that people are living longer and are engaging in more outdoor lifestyles.
Although for the last five years he hasn’t been treating AK patients frequently, Leo Indianer, M.D., of Encino, CA, did treat them regularly for 31 years before deciding to read slides for other dermatologists as a dermato-pathologist. His input for this article provides information from a different angle. He says it’s hard to say if there’s more cases these days because of the newer modalities of treatment that can bring out the AK without the need for biopsy — which is the side of it that he’s involved with now.
Twenty-four year AK veteran, Jeffrey P. Callen, M.D., of Louisville, KY, agrees with Dr. Perniciaro in that there are more cases of AKs today. “I see many more organ transplant recipients and my patients have aged as I’ve been in practice,” he states.
Darrell S. Rigel, M.D., of New York City, also thinks that there are more cases of AKs in practices today, but he offers a different reason: “Because there’s a 10- to 20-year delay of damage, we’re seeing today what damage people did in the 80s.” He adds that we may also see less in the next 10 or 20 years because of the delay factor and because patients are a little bit more aware of the condition. He also cites the fact that people are living longer, which may also add to why it seems the incidence of AKs have increased. Dr. Rigel has been in practice for 23 years.
Scott D. Glazer, M.D., of Chicago, who’s been in practice for 20 years, says that AK is probably a little more prevalent these days, but “it’s been fairly common throughout the years.”
Sandra K. Surbrugg, M.D., of Cheyenne, WY, who’s been in practice for 16 years, also says she’s seen an increase in the number of cases compared to a decade ago.
A profile of the AK patient
The practitioners we talked to see about the same amount of AK patients per day. Dr. Glazer says on an average day he sees about 10 AK patients, typically presenting as a light-skinned person with one or multiple red, scaly spots on his or her face — less commonly on the back of the hands and arms. Dr. Surbrugg also sees about 10 AK patients per day. Her patients are typically concerned about tender lesions on sun-exposed skin that aren’t healing.
Per day, Dr. Perniciaro sees about 15 who typically present with a crusted, slightly tender, small patch in a sun-exposed area. Dr. Indianer sees at least 20 patients per day microscopically. Recalling back to when he treated AK patients in his practice, he says that the typical patient presented with rough scaling on sun-damaged skin. The typical AK presentation Dr. Rigel encounters is severe sun damage on the several AK patients he sees per day.
Dr. Callen says the number of AK patients he sees in his office per day is variable — ranging from one to 15. “They typically present with a scaly, often irritated patch on an exposed surface.”
As you’re aware, AKs are known as the early beginnings of skin cancer. With this in mind, it makes sense to think that people would be more aware of the risk they take when they spend long hours in the sun without sunscreen. Some of the practitioners we spoke with agree with this thought; others disagree.
“People are more aware,” says Dr. Glazer. “There’s a lot of coverage in the media and people see that President Bush had AK and that President Clinton had basal cell carcinoma. Also, people see them because they’re on the skin. Sometimes patients are nervous about them and don’t like the way they look.”
He says he’s seeing a slightly younger population now, but that people are more aware of sunscreen and the use of it seems to be cutting down on problems. Dr. Surbrugg agrees that patients are more aware of skin cancer and AKs today.
Says Dr. Perniciaro, “Over the last 10 years, patients are much more aware of skin conditions. Many people just come in for a skin check — I can’t even remember 10 years ago that anyone would just come in to have me check their skin when they weren’t aware of a problem.”
Dr. Indianer, who, remember, works as a pathologist, has a different opinion of the patient aspect. He doesn’t think patients are more aware of AKs. “They’re still in denial,” he says.
Dr. Rigel and Dr. Callen are on the same side of the fence as Dr. Indianer. Says Dr. Rigel, “I don’t think many patients are concerned with the prevention of AKs — most of them don’t even know what AKs are. They are, however, concerned with skin damage and the effects of sun exposure on the aging process.”
Where They Stand on the Topic
There’s some different thinking about whether AKs are pre-malignant, malignant or neither. Some believe in a continuum theory, as does Dr. Perniciaro. He considers AKs to be pre-malignant “in a spectrum that leads to malignancy.” He explains that if you pick out an AK at any point of time, it could be malignant 6 weeks later.
Drs. Glazer, Callen, Rigel and Indianer all regard AKs as pre-malignant, though Dr. Rigel considers them pre-malignant to incipient malignant. Dr. Indianer regards the proliferative AK with extension along adnexal as an early type of malignancy, and this malignancy requires more careful follow-up.
Dr. Surbrugg, who agrees AKs are pre-malignant, says “the distinction is blurred both clinically and histologically between a hypertrophic AK and an SCC (squamous cell carcinoma).”
What are They Using?
So now come the questions you’ve all been waiting for:
l What therapies are these doctors using to treat AKs?
l What do they think of the newer methods?
l How do they select patients for treatment?
We’ll hear these experts’ answers to these questions.
Dr. Rigel’s gold standard therapy is cryotherapy, but he does a biopsy when he’s not sure if the area of skin is invasive. “I use a little bit of everything — photodynamic therapy (PDT) is useful for a whole area of multiple lesions and I use imiquimod (Aldara) topically for multiple lesions also.” He basically treats all patients and says that the big issue he faces is whether to biopsy them.
In 99% of cases, Dr. Perniciaro says he uses cryotherapy (liquid nitrogen in a pressurized container and squirted through a trigger). He only uses 5-fluorouricil sometimes and he’s tried imiquimod, but says it’s equivocal at best. “If a patient has diffuse, wide spread areas of damage where I can’t focus the trigger to spray the area, then they’re a candidate for the 5-fluorouricil, but I don’t use the other stuff (PDT and imiquimod),” says Dr. Perniciaro.
Dr. Surbrugg typically treats her patients with cryotherapy, using a Cryac, about every 3 to 6 months. She also treats two to three patients per day in her facility’s new PDT unit. She’s only been using it for 15 months, but says the response has been favorable, despite the fact that it’s a painful treatment. “The patients like the excellent cosmetic result with healing without hypopigmentation, unlike cryotherapy,” she explains. She selects patients by assessing the number, type and location of the lesions, and has found that hypertrophic lesions don’t respond as well to PDT.
Dr. Callen’s AK patients learn about cryotherapy because that’s what he uses on most of them. He says, “I reevaluate them 6 to 8 weeks after treatment and then I re-treat them if necessary. For patients who have multiple lesions, I may choose 5-fluorouricil or imiquimod or diclofenac sodium (Solaraze).” He has tried PDT, one of the newer methods of treating AKs. “We were part of a study for PDT, but I don’t think it’s practical for my office or for my patients,” he admits.
The gold standard of therapy for Dr. Glazer is 5-fluorouricil, but he says it all depends on the number of lesions a patient has. “If it’s something less than 10, then I use cryotherapy, but if there’s a lot of sun damage with AK, then I use Efudex, which is a 5% concentration of fluorouricil.”
Dr. Glazer tested PDT for the company and uses it on a limited basis — mainly for patients who have multiple lesions. He says, “Statistically, imiquimod has a better cure rate, but on the other hand, it causes more irritation, redness and discomfort.” He, like Dr. Surbrugg, selects patients for treatment by the number and location of their lesions. Generally he treats most lesions unless the patients is infirm or they have other health issues. “When I was younger, I used to treat all cases, but now I sometimes follow some of the cases. If the numbers are low, I’ll just freeze them — it works well and is effective and quick,” he says.
Feeling Out the New Terrain
You’ve probably realized that these practitioners don’t handle AK patients much differently than you do. However, it’s good to get a feel of what other professionals in your field are doing from time to time. These doctors are seeing quite a few AKs per day in their practice and it sounds as though they’re pretty much sticking to the tried-and-true methods they’ve come to trust over the years. But give it some more time, and the next time we revisit this topic, we just may see that many of these M.D.s, and others, have changed their tune and have started using the newer therapies more regularly.Actinic Keratoses. You’ve seen its victims before — the sun gods and goddesses who walk into your office radiating heat from years of accumulated sun exposure. Or maybe the fair-skinned patient who haplessly spent too many hours in the sun over the last few years. Whatever the patient’s physical appearance or leisure activities, the clinical presentations are always similar — rough, scaly skin; bumpy, mottled skin; or cutaneous horn.
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