Facial skin resurfacing with lasers, an acid skin peel or a topical cream may reduce the number of precancerous skin lesions and lower the risk of developing skin cancer, according to a report in the August issue of the Archives of Dermatology, one of the JAMA/Archives journals.
Approximately 3.7 million physician visits occur in the United States every year for actinic keratoses, skin lesions that are sensitive to the effects of ultraviolet light. About 331 per 100,000 such lesions per year will progress into the skin cancer squamous cell carcinoma in patients older than age 40 years, according to background information in the article. As many as one-fourth of patients with multiple actinic keratoses will develop squamous cell carcinoma, and up to 60 percent of such cancers are thought to originate from actinic keratoses. Current treatment generally involves freezing the lesions with liquid nitrogen. "However, despite an overreliance by dermatologists on liquid nitrogen, there are, to our knowledge, no published studies that justify this expensive treatment modality as an efficient means to reduce the financial impact of actinic keratoses and nonmelanoma skin cancer on the health care system," the authors write.
Basil M. Hantash, M.D., Ph.D., and colleagues at Veterans Affairs Palo Alto Health Care System and Stanford University Medical Center, California, evaluated three alternative treatments for actinic keratoses in 24 patients with a history of lesions or of carcinoma. The participants had an average age of 73 years and were randomly assigned to undergo skin resurfacing with either a carbon dioxide laser, a chemical peel using 30 percent trichloroacetic acid or a cream with 5 percent fluorouracil, a medication used in chemotherapy, applied twice daily for three weeks. Dermatologists charted patients' actinic keratoses on a diagram of the head at the beginning of the study and again every three months for a period of at least 24 months. Five patients who were eligible for the study but declined treatment were used as controls.
After three months, the number of actinic keratoses had decreased significantly in all three treatment groups: 83 percent in the fluorouracil group, 89 percent in the acid group and 92 percent in the laser group. None of the participants experience adverse effects from treatment. The risk of cancer was also lower in all three treatment groups than in the control group; patients in the acid group, in particular, had a 40-fold lower rate of nonmelanoma skin cancer than those in the control group. Patients in that group also reported fewer complaints, less discomfort and a faster healing time than those in the other two treatment groups.
"Improved patient compliance in the trichloroacetic acid arm, ease of performance in the outpatient setting and subjective measures of better tolerance for this procedure make it an attractive alternative to repeated courses with topical agents or laser resurfacing," the authors conclude. "A larger study comparing trichloroacetic acid resurfacing for actinic keratosis reduction and nonmelanoma skin cancer prophylaxis [prevention] would help validate the superiority of this resurfacing technique over the carbon dioxide laser and assess its cost-effectiveness" compared with other therapies.
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