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The FP recognized that the lesions on the back of the hands were due to sun damage and included actinic keratosis. However, he was concerned that some of the thicker lesions could be squamous cell carcinoma or SCC in situ.
He discussed options with the patient, which included biopsy of the thickest lesions, cryotherapy, and/or field treatment with a topical agent. The decision was made to biopsy the 2 thickest and whitest lesions and do cryotherapy on some of the other lesions. Shave biopsies were performed and the patient was encouraged to wear sunscreen and minimize his sun exposure. (See the Watch & Learn video on “Shave biopsy.”) On the follow-up visit 2 weeks later, the FP noted that the biopsies and frozen areas were healing. Both biopsies were hypertrophic actinic keratoses only.
The FP then prescribed 5-fluorouracil to be used for 3 to 4 weeks on the remaining lesions on the backs of his hands and forearms. The patient was directed to treat the right arm first to allow more time for the left hand to heal. He was told to stop the 5-fluorouracil if the area became too painful. The patient was also told to treat his left arm the same way after allowing the right arm to heal. Any areas of skin ulceration could be treated with plain petrolatum, but no topical steroids are needed.
Six months later, the patient’s arms and hands looked much better. The patient required regular follow-up.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R, Wah Y. Actinic keratosis and Bowen disease. In: Usatine R, Smith M, Mayeaux EJ, et al. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:969-976.
To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/.
You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com.
The FP recognized that the lesions on the back of the hands were due to sun damage and included actinic keratosis. However, he was concerned that some of the thicker lesions could be squamous cell carcinoma or SCC in situ.
He discussed options with the patient, which included biopsy of the thickest lesions, cryotherapy, and/or field treatment with a topical agent. The decision was made to biopsy the 2 thickest and whitest lesions and do cryotherapy on some of the other lesions. Shave biopsies were performed and the patient was encouraged to wear sunscreen and minimize his sun exposure. (See the Watch & Learn video on “Shave biopsy.”) On the follow-up visit 2 weeks later, the FP noted that the biopsies and frozen areas were healing. Both biopsies were hypertrophic actinic keratoses only.
The FP then prescribed 5-fluorouracil to be used for 3 to 4 weeks on the remaining lesions on the backs of his hands and forearms. The patient was directed to treat the right arm first to allow more time for the left hand to heal. He was told to stop the 5-fluorouracil if the area became too painful. The patient was also told to treat his left arm the same way after allowing the right arm to heal. Any areas of skin ulceration could be treated with plain petrolatum, but no topical steroids are needed.
Six months later, the patient’s arms and hands looked much better. The patient required regular follow-up.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R, Wah Y. Actinic keratosis and Bowen disease. In: Usatine R, Smith M, Mayeaux EJ, et al. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:969-976.
To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/.
You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com.
The FP recognized that the lesions on the back of the hands were due to sun damage and included actinic keratosis. However, he was concerned that some of the thicker lesions could be squamous cell carcinoma or SCC in situ.
He discussed options with the patient, which included biopsy of the thickest lesions, cryotherapy, and/or field treatment with a topical agent. The decision was made to biopsy the 2 thickest and whitest lesions and do cryotherapy on some of the other lesions. Shave biopsies were performed and the patient was encouraged to wear sunscreen and minimize his sun exposure. (See the Watch & Learn video on “Shave biopsy.”) On the follow-up visit 2 weeks later, the FP noted that the biopsies and frozen areas were healing. Both biopsies were hypertrophic actinic keratoses only.
The FP then prescribed 5-fluorouracil to be used for 3 to 4 weeks on the remaining lesions on the backs of his hands and forearms. The patient was directed to treat the right arm first to allow more time for the left hand to heal. He was told to stop the 5-fluorouracil if the area became too painful. The patient was also told to treat his left arm the same way after allowing the right arm to heal. Any areas of skin ulceration could be treated with plain petrolatum, but no topical steroids are needed.
Six months later, the patient’s arms and hands looked much better. The patient required regular follow-up.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R, Wah Y. Actinic keratosis and Bowen disease. In: Usatine R, Smith M, Mayeaux EJ, et al. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:969-976.
To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/.
You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com.
