What is your treatment approach to patients with confluent actinic keratoses on lower extremities?

I find these patients can be very challenging to treat. It is difficult to completely clear the AKs and even if there is success initially, these patients will often develop new adjacent lesions or recurrent lesions within a short time. Nonetheless, we have used various approaches to treating these patients. In general, I use a keratolytic to help chemically debride any hypertrophic lesions (20% urea or Amlactan) for at least 2-4 weeks before whichever field treatment is used. Skin cancers that ...

For these field cancerization patients, I definitely appreciate and agree with Dr. @Dr. First Last's thorough answer.

I like to separate the treatment areas into different zones and tackle them over various stages or visits.

I also like to have patients start acitretin 25mg 2 or 3 times a week (approximately 2-4 weeks prior) to reduce the proliferative capacity of the epidermis in order to minimize the risk of eruptive KAs. This is continued until the treatment process is complete, and can also ...