In this episode of The Spot Check, host Jamie Restivo, MPAS, PA-C, welcomes Fabrizio Galimberti, MD, PhD, dermatologist and Medical Director at Conway Medical Center, for an engaging discussion on one of the most common yet deceptively complex conditions seen in clinical practice, actinic keratoses (AKs).

Dr Galimberti emphasizes the importance of distinguishing AKs from “dry skin,” reminding listeners that these are pre-cancerous lesions with the potential to progress to squamous cell carcinoma, which is responsible for more deaths annually than melanoma. Together, he and Restivo unpack the art and science of combining cryotherapy and field therapy, with data showing a reduced burden of both pre-cancerous and cancerous lesions when these treatments are paired. “This is a chronic condition,” Dr Galimberti notes. “We need to treat for now and for the future.”

The conversation explores how photodynamic therapy (PDT) fits into the AK treatment paradigm, offering controlled, in-office precision with cosmetic benefits and no risk of scarring. Dr Galimberti outlines his evolving patient-selection criteria, insights on optimizing incubation times, and the growing promise of painless PDT. He also shares pragmatic workflow pearls, like scheduling PDT and follow-up appointments simultaneously, to improve adherence and outcomes.

Listeners will gain a grounded, practice-ready framework for treating AKs holistically: balancing efficacy, tolerability, and patient experience while addressing both visible and subclinical disease.