Data do not support aggressive removal of actinic keratoses. (High Regression Rate).

PARIS -- Massive campaigns aimed at detection and treatment of actinic keratoses aren't currently justified by scientific evidence, Dr. Martin A. Weinstock said at the 20th World Congress of Dermatology.

Available data suggest that actinic keratoses (AK) often remit spontaneously. They also have a low rate of malignant transformation, said Dr. Weinstock, professor of dermatology and director of the divisions of photomedicine and dermatoepidemiology at Brown University Providence, R.I.

Moreover, physicians do a poor job of recognizing AKs, he added, citing his own study involving seven distinguished dermatologists with more than 100 years of experience whom he persuaded to independently count AKs on nine patients on the same day (Arch. Dermatol. 137[8]:1055-58, 2001).

"Many of the seven were academic names that you would recognize," Dr. Weinstock said. But their fame and clinical experience didn't bring consensus. Their counts varied enormously. For example, in one patient, the number of AKs identified ranged from 30 to 105, in another, from 6 to 27.

"Basically they were all over the map. It's a very unreliable diagnosis. That makes it difficult to justify a campaign treating all actinic keratoses, since you can't diagnose them reliably.

Roughly 3 million patient visits per year-9% of all visits to American dermatologists--are for AKs, according to data from the Centers for Disease Control and Prevention's National Ambulatory Medical Care Survey. That's more than for psoriasis, eczema, or skin cancer. Most of these visits include cryosurgery or other treatment.

Campaigns, such as the one currently underway in the United States encouraging treatment of AKs, have the undesirable side effect of crowding out needier patients, such as those with psoriasis or lesions suspicious for melanoma, who are ...