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Actinic keratoses — ABIM Board MCQ

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ModerateDermatologyActinic keratosesABIM Board

A 70-year-old with extensive sun exposure has numerous rough scaly papules across the balding scalp, without induration, rapid growth or ulceration. Which management is appropriate?

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Correct answer: C — Counsel rigorous sun protection and discuss field-directed treatment for actinic keratoses

The best answer is “Counsel rigorous sun protection and discuss field-directed treatment for actinic keratoses”. Actinic keratoses mark cumulative ultraviolet damage and can progress to squamous-cell carcinoma. Multiple lesions across a field can be treated with options such as topical 5-fluorouracil or photodynamic therapy, alongside sun protection. Induration, pain, rapid growth or ulceration would increase concern for invasive disease and prompt biopsy.

Reference: American Academy of Dermatology Actinic Keratosis Guideline: https://www.aad.org/member/clinical-quality/guidelines/actinic-keratosis