What to consider in Primary Care before referring:
General Comments
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Also known as actinic keratoses, are usually multiple, flat reddish brown lesions with a dry adherent scale.
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The vast majority of solar keratoses DO NOT progress to squamous cell carcinoma.
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Evidence suggests that the annual incidence of transformation from solar keratoses to SCC is less than 0.1%. This risk is higher in immunocompromised patients.
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It is not necessary to refer all patients with solar keratoses.
Treatment in primary care
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Diclofenac Sodium (Solaraze) - Twice daily for 3 months.
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Topical 5-Fluorouracil (Efudix) Apply once to twice daily for 3 to 4weeks.
This is the ideal treatment for widespread, multiple, ill-defined solarkeratoses. It spares normal skin, allowing application to a wide skin surface. It is safe, efficacious, with little systemic absorption. Marked inflammation occurs prior to resolution and the patient must be warned to expect this.
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Other treatments (For isolated, well-defined lesions):
Cryotherapy - light freezing for 5-10secs
Topical imiquimod
Photodynamic therapy
Surgery
Referral Threshold
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If there is suspicion of malignancy.
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If the lesions have not responded to treatment.
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If the individual is on immunosuppressants (e.g. post-renal transplants)
