Case-based Considerations in the Treatment of Actinic Keratoses: Utilizing Combination or Sequential Therapy With 5-fluorouracil Cream and Destructive Treatments

Dermatologic conditions associated with prolonged sun exposure represent a substantial portion of visits to the dermatologist’s office, particularly among elderly populations. Actinic keratoses are premalignant lesions that increase in frequency with each decade of life and have the potential to progress to squamous cell carcinoma. Non-melanoma skin cancers, such as squamous cell carcinoma and basal cell carcinoma, also represent sun-related conditions that require early and aggressive treatment. Therapeutic options for these conditions are abundant and range from topical field-directed therapies to destructive, lesion-directed procedures. Choice of therapy depends on the types and extent of lesions with which a patient presents; often, a combination of treatments provides the optimal means for successful outcomes. The following case-based review represents typical situations where multiple treatments were combined to manage actinic keratosis, squamous cell carcinoma and basal cell carcinoma in patients over an extended treatment period.