In this episode of Topical Conversations, Gary Goldenberg, MD, discusses photodynamic therapy (PDT) as a valuable tool in managing actinic keratoses (AKs). 

Reassessing AK treatment strategies 

AKs pose a significant challenge in dermatologic practice due to their potential progression to keratinocyte carcinomas, such as squamous cell carcinomas. 

Dr Goldenberg likens the conventional approach of treating each individual AK to pulling weeds out of a garden one by one. This analogy underscores the limitation of solely targeting visible lesions while neglecting subclinical AKs that may be present. Numerous studies support the existence of subclinical AKs, emphasizing the need for a treatment modality that addresses both the visible and invisible manifestations of these precancerous growths. 

Integrating PDT into your practice 

PDT is a valuable option for managing both visible and invisible subclinical AKs and is an easy treatment to integrate into a practice. The procedure involves the application of a PDT agent, chosen based on the provider’s preference, followed by a 30 to 60-minute wait. Next, patients are exposed to blue or red light, or laser devices if preferred. 

A proactive strategy to prevent skin cancer 

Dr Goldenberg encourages patients with multiple AKs to undergo PDT 2 to 4 times per year and views this proactive, regular approach as an investment in patients’ future health. By consistently reducing the number of visible and subclinical AKs, dermatologists aim to theoretically decrease the likelihood of developing keratinocyte carcinomas, offering effective long-term benefits to patients.