INTRODUCTION
Actinic keratosis (AK) is a marker for photodamaged skin.1 Dermatologists treat AKs primarily because these lesions have the potential to progress to invasive squamous cell carcinoma (SCC). Most patients seek treatment to remove the lesions and achieve improved cosmesis of the skin following treatment.2 When determining which treatment to use in a patient presenting with AK, dermatologists generally consider a variety of factors, such as patient preference, cost and availability of treatment, location of lesions, tolerance for adverse events, and the need for field therapy (ie, the number of lesions in a discrete area).3,4 Cosmesis following treatment should also be considered, especially for patients who are particularly concerned about their skin’s appearance, because cosmetic outcomes differ across AK treatments.5 However, there is only limited research on cosmetic outcomes following treatment of AK, hindered by the absence of reliable, reproducible, and valid, condition-specific assessments, including patient-reported outcome (PRO) instruments.6,7 Currently available outcome measures of cosmesis are specific for photodamage, not AKs.To address the subject of cosmetic outcomes following treatment of AK, an expert panel of seven dermatologists was convened in Miami, Florida, on February 11, 2016. The objectives of the meeting were to (1) define cosmesis in the context of AK from clinicians’ and patients’ perspectives, (2) review current management options for photoaging and AK, (3) analyze currently available cosmetic outcome assessment methods used by investigators and clinicians, especially in terms of their utility, and (4) propose optimal assessment tools for cosmesis following treatment of AK and outline a strategy for validation and future application of these tools in clinical research that would be acceptable to regulatory agencies.This article summarizes the panel’s discussions on photoaging, AKs, treatment, and cosmesis assessments, including their personal clinical experience and evidence from the published literature.Photoaging The skin is the only organ that is chronically exposed to the environment.8 Chronologic, or biologic skin changes (intrinsic
