Should I schedule a dermatology appointment for a skin cancer check-up given my history of atypical actinic keratosis and presence of concerning skin lesions on my head and arms?

From the Guidelines

You should schedule an appointment with West Ada Dermatology as soon as possible, given your history of atypical actinic keratosis and the presence of new concerning spots on your head and arms. The recommendation for six-month check-ups by the dermatology office should be followed, especially since you've only been seen once since the COVID pandemic ended. Actinic keratoses are precancerous lesions that can potentially develop into skin cancer, and the "atypical" and "inflamed" description in your biopsy result suggests these require closer monitoring 1. Some key points to consider include:

• The fact that you have new concerning spots is an important reason to be evaluated sooner rather than later.
• Although your records indicate "no indication for dermatology referral at this time," this likely refers to a previous assessment, and new or changing lesions warrant reevaluation.
• Regular skin checks are important for early detection of skin cancer, particularly for someone with your history.
• The guidelines of care for the management of actinic keratosis emphasize the importance of shared decision-making between the clinician and the patient, and the choice of optimal therapy will ideally involve this shared decision-making 1. Contact West Ada Dermatology to schedule an appointment, mentioning your history and new concerns.

From the Research

Skin Cancer Check-up and Actinic Keratosis Management

• The user has been recommended to have periodic skin assessments and to contact West Ada Derm if any changes occur, with a last biopsy showing ATYPICAL ACTINIC KERATOSIS, INFLAMED 2, 3, 4, 5.
• Actinic keratosis (AK) is a chronic skin condition that can be a precursor to cutaneous squamous cell carcinoma, and it is important that AK lesions are managed appropriately 2, 3, 4, 5.
• The management of AKs is divided into lesion-directed and field-directed therapies, with current therapies including lesion-directed cryotherapy and/or excision, and topical field-directed creams: 5-fluorouracil, imiquimod, diclofenac, photodynamic therapy, and ingenol mebutate 3, 4, 5.

Treatment Options for Actinic Keratosis

• A systematic review of treatment options for AKs found that photodynamic therapy (PDT), cryotherapy, imiquimod, ingenol mebutate (IMB), 5-fluorouracil (5-FU), trichloroacetic acid (TCA), and ablative fractional laser (AFXL) were all non-inferior to one another in terms of percent clearance of AKs 5.
• The review also found that 5-FU, combination PDT, and combination 5-FU with calcipotriol were the most beneficial for AKs on the head and neck, although they often caused the highest proportion of initial side effects 5.
• A real-world approach to AK management suggests that treatment goals should be to reduce the number of lesions, achieve long-term disease control, and prevent disease progression to invasive squamous cell carcinoma 4.

Request for Appointment

• Given the user's history of AK and the presence of multiple spots on their head and arms that concern them, it is reasonable to request an appointment with West Ada Derm for a skin cancer check-up 2, 3, 4, 5.
• The user's last biopsy showing ATYPICAL ACTINIC KERATOSIS, INFLAMED, and the lack of indication for a dermatology referral at this time, do not necessarily preclude the need for a follow-up appointment to monitor the user's condition and provide guidance on management and treatment options 2, 3, 4, 5.