Several chemopreventive modalities to treat actinic keratoses and prevent skin cancer are available and should be aggressively pursued. An experienced board-certified dermatologist with keen interest in Preventive Dermatology and Chemoprevention can outline pros and cons of topical 5-flurouracil, imiquimod, photodyanimc therapy, chemical peel, laser resurfacing, even oral acitretin (Vitamin A).
Deciding factors of utilizing any of above suggested modalities depend on location to be treated, one's priorities and schedules. For example, topical chemopreventive creams such as 5-flurouracil (e.g. Carac, Efudex) or imiquimod (Aldara) are more amenable to areas such as arms, chest of women or scalp in men as the 'down time' could last 3-4 weeks but can be covered up with clothing or hat. Whereas photodynamic therapy (PDT), chemical peel, Fractional CO2 laser resurfacing are more appropriate for the face where the 'down time' typically does not exceed one week.
Keep in mind that the extent of inflammation associated with these chemopreventive modalities is correlated with the extent of underlying sun damage. In other words, if there is minimal sun damage in areas treated, there should not be significant irritation. However, if there is significant precancerous lesions, it is better for them to be brought out to the surface and be dealt with before they turn cancerous and require surgical excision. The irritation/inflammation from topical chemopreventive creams and PDT are not only diagnostic (e.g. identifying the locations of precancerous changes) but also therapeutic.
For women and men who want to get some cosmetic benefits while addressing medical concerns of sun damage and precancerous changes, TCA chemical peels and Fractional CO2 laser resurfacing can be fantastic options.
