Management of Biopsy-Confirmed Actinic Keratosis

Introduction to Management

The British Journal of Dermatology recommends that most patients with biopsy-confirmed actinic keratosis can be managed in primary care without dermatology referral, using topical therapies or cryosurgery 1

The British Journal of Dermatology suggests that patients with mild disease (few lesions) and a simple, uncomplicated AK confirmed by biopsy can be confidently managed in primary care 3
Patients who are not immunosuppressed and have lesions that respond to standard first-line treatments can also be managed in primary care 1, 4

The British Journal of Dermatology recommends 5-fluorouracil cream, diclofenac gel, and ingenol mebutate as effective topical therapy options for actinic keratosis 5
Cryosurgery (liquid nitrogen) is a flexible and effective physical therapy option for lesion-based treatment, and can be performed in primary care settings 5, 7

The British Journal of Dermatology advises referral to dermatology via urgent 2-week cancer pathway for patients with bleeding, painful, or thickened lesions, as these may indicate invasive squamous cell carcinoma 1
Patients with treatment failure, multiple or relapsing AKs, or those who are long-term immunosuppressed should also be referred to dermatology 1

The British Journal of Dermatology emphasizes that actinic keratosis is a chronic disease requiring ongoing management, and patients should be educated about the risk of developing additional AKs, association with increased risk of squamous cell carcinoma, and importance of sun protection 1, 3, 8
Patients should be advised to self-monitor for new or changing lesions and return for evaluation if they experience new bleeding, pain, or rapid growth 1, 3