TDNet Discover

Background: With more people diagnosed with skin cancer each year than any other cancer combined, the treatment of precancers is more important than ever. Actinic keratosis is the most common form of skin precancers and a common reason patients visit the dermatologist. When left untreated, these precancers have a 30% chance of progressing to squamous cell carcinoma. Objective: The purpose of this research is to determine if providers prefer 5-fluorouracil or photodynamic therapy (PDT) to treat actinic keratosis treatment and what factors contribute to this preference. Methods: A 21 question electronic survey was emailed to dermatology providers in the Southeastern region of the U.S. via Qualtrics to evaluate providers’ treatment preference of actinic keratoses and the factors that contribute to their choice. The results were analyzed by an independent Statistician to determine the treatment plan preferred overall and by provider level of care. Following an approval and pilot period, the survey was emailed to Dermatology providers currently practicing in the Southeastern region. Results: The most significant finding from this study showed 5-FU is the preferred treatment by PAs and MDs, while PDT is the preferred treatment by NPs. The data indicated that although 5-FU was the overall preferred treatment, PDT was found easier to use but costs more and requires more follow-up. When providers are concerned with patient treatment compliance or have a female patient who wants secondary skin and cosmetic benefits, PDT is the treatment of choice. Our data showed that 5-FU was reported to have more adverse drug effects with the most common reaction being erythematous skin changes and temporary pain Additionally, 5-FU treatment was associated with lower cost to the patient and better results in 3 months and 1-2 years. Although PDT contributes a higher profit for clinics, the majority of providers still chose iv 5-FU for its low cost, consistency, effectiveness, and lasting results. Research showed that 5-FU is the preferred treatment when treating multiple areas of actinic keratoses, however PDT was more commonly reported to treat AKs on the face. Overall, a higher treatment compliance was reported with 5-FU with the exception of the scalp and face treated with PDT had a higher treatment compliance. Conclusion: The data gathered from this study concluded that clinicians preferred 5-FU over PDT therapy in the treatment of actinic keratoses. Dermatology providers possess pivotal roles to help patients make health decisions and it is important to consider each patient individually as patients may pose considerations that do not align with the preferred treatment. As a medical professional, it is your due diligence to use shared decision making in order to make the best decision for the patient. To advance the findings of this research, further studies should be done to expand the sample size and geographic location to determine if different regions may affect a provider’s preferred treatment due to weather and/or season changes yearly. Additionally, we would welcome further research to include newer treatments, such as Klisyri, more widely-used topical treatments, laser therapy, and use of liquid nitrogen.