From the Guidelines
You should continue with periodic skin assessments as recommended by West Ada Derm, and contact them if you notice any changes in your skin. Your last biopsy showed an inflamed atypical actinic keratosis, which is a precancerous skin lesion caused by sun damage, as defined by the guidelines of care for the management of actinic keratosis 1. While this condition requires monitoring, it does not currently warrant a dermatology referral. Actinic keratoses can sometimes progress to squamous cell carcinoma, though most do not, and the management of AK is likely to be an ongoing process for most patients, involving shared decision-making between the clinician and the patient 1.
The guidelines recommend the use of UV protection for patients with AK, as a good practice statement 1. Regular self-examinations between professional assessments are important - look for new rough, scaly patches, especially on sun-exposed areas like face, ears, scalp, neck, and hands. Use sun protection daily (broad-spectrum SPF 30+ sunscreen, protective clothing, wide-brimmed hats) to prevent further damage, as recommended by the guidelines 1. If you notice any lesions that become larger, redder, more tender, or develop ulceration, contact West Ada Derm promptly as these could indicate progression requiring treatment.
It is essential to note that various AK treatments, including topical agents, cryosurgery, and photodynamic therapy (PDT), are considered in the guidelines, and the choice of optimal therapy will ideally involve shared decision-making between the clinician and the patient 1. However, based on the current information, periodic skin assessments and sun protection are the recommended course of action, and you should follow the guidelines provided by West Ada Derm and contact them if you notice any changes in your skin.
From the FDA Drug Label
The treatment area should not be bandaged or otherwise occluded Patients may experience local skin reactions during treatment with Imiquimod Cream (even with normal dosing). Potential local skin reactions include erythema, edema, vesicles, erosions/ulcerations, weeping/exudate, flaking/scaling/dryness, and scabbing/crusting Local skin reactions may be of such an intensity that patients may require rest periods from treatment Treatment with Imiquimod Cream can be resumed after the skin reaction has subsided, as determined by the physician
The patient has been diagnosed with Atypical Actinic Keratosis, Inflamed. Given the information provided, there is no indication for a dermatology referral at this time. The recommended course of action is to continue with periodic skin assessments as advised by West Ada Derm.
- The patient should be aware of potential local skin reactions associated with imiquimod cream treatment, such as erythema, edema, and flaking/scaling/dryness.
- It is essential to follow the prescribed treatment regimen and attend scheduled follow-up appointments to monitor the condition and adjust treatment as necessary 2.
From the Research
Diagnosis and Treatment of Actinic Keratosis
- Actinic keratosis (AK) is a premalignant lesion that can evolve into squamous cell carcinoma, and its treatment is crucial to prevent malignancy and further complications 3, 4.
- The decision to treat AK can be based on cosmetic reasons, symptom relief, or the prevention of malignancy and metastasis 4.
- Treatment options for AK include ablative therapies such as cryosurgery, curettage with electrosurgery, and photodynamic therapy, as well as topical therapies like 5-fluorouracil, imiquimod, and diclofenac 3, 4, 5.
Management and Prevention of Actinic Keratosis
- Education about sun exposure prevention remains the best and most cost-effective method for AK prevention 3.
- AK can undergo spontaneous regression, stable existence, or malignant transformation to cutaneous squamous cell carcinoma, with progression rates to SCC ranging from 0% to 0.5% per lesion-year 6.
- Patient-centered management of AK is essential, and patients should be involved in treatment decisions, with consideration of their psychosocial characteristics and needs 7.
Treatment Options for Atypical Actinic Keratosis
- Atypical actinic keratosis, like the one mentioned in the biopsy results, can be treated with the same options as AK, including topical therapies and ablative therapies 3, 4, 5.
- The choice of treatment depends on various factors, including the size and location of the lesion, the patient's overall health, and their preferences 4, 7.