Actinic Keratoses and PDT

Neal Bhatia, MD opened by underscoring the growing global burden of non-melanoma skin cancer (NMSC), which now causes more annual deaths than melanoma. Because the vast majority of invasive squamous cell carcinomas arise from background actinic damage and clinicians cannot predict which individual AK will progress, he emphasized a proactive field-treatment strategy rather than lesion-by-lesion destruction. Advances in topical therapy support this approach, including tirbanibulin 1% ointment, now approved for larger treatment fields and shown to induce apoptosis with less inflammation, and combination calcipotriol plus 5-fluorouracil, which enhances antitumor immunity and significantly lowers long-term SCC risk.

Photodynamic therapy (PDT) remains a highly effective field treatment, with pivotal studies of 10% ALA gel plus red light demonstrating durable clearance rates exceeding 80% at 12 months. Expanded FDA approval now allows treatment of larger surface areas with excellent tolerability, and PDT continues to show strong efficacy in facial SCC in situ and superficial basal cell carcinoma. Dr Bhatia addressed common barriers to PDT adoption, particularly treatment-related pain, sharing practical mitigation strategies such as cooling measures, antihistamines, anxiolytics, and emerging short-contact protocols that preserve efficacy while improving patient comfort, especially on the face.

The session concluded with pragmatic office pearls, including structuring PDT as a dedicated service line with streamlined scheduling, seasonal timing considerations, and appropriate CPT coding when clinicians directly administer therapy. Dr Bhatia emphasized that when used thoughtfully, PDT is not only an effective AK treatment but also a powerful preventive tool against future skin cancer.