Neal Bhatia, MD: Which Patients Are Most At Risk for Actinic Keratosis?

In this segment of his HCPLive interview, Neal Bhatia, MD, discussed treatment advances and important facts to take away from his talk ‘What You Need To Know NOW About Actinic Keratosis’ at the 2023 Fall Clinical Dermatology Conference in Las Vegas.

Bhatia works as a dermatologist in Southern California, as well as director of clinical dermatology at Therapeutics Clinical Research and chief medical editor for Practical Dermatology.

He went into a discussion about treatment advances as well as diagnostic tools for actinic keratosis (AK).

“I think the best diagnostic tools you have are your 2 eyes and your 2 hands,” Bhatia explained. “ I think feeling and looking just like we go to the dentist when they catch something, we do this with their skin. We have the patients do this, getting them out of the mindset of dry skin versus what's a pre-cancerous spot or actinic keratosis is pivotal.”

Bhatia noted that there is now data suggesting that cosmetology schools and aestheticians are now being trained on identifying skin cancers, a fact which he states is helpful because they are getting patients to become more aware.

“The bigger part of the equation is the topical programs and treatments that we have, such as with tirbanibulin ointment, for example,” he said. “We've got large surface area data that's being presented at a lot of these meetings now, which means we can now use it over 100 square centimeters, which is really exciting because the local skin reactions are the same as with the small surface area. But we're able to cover a lot of surface area now with very little or no worries about pharmacokinetics or absorption.”

Bhatia added that there is some new data on both blue light and red light photodynamic therapy (PDT).

“I think one thing we all have to remember is making sure our documentation is adequate, as well as the matching of the J-codes and the CPT codes,” he explained. “And most important is making sure that the clinician is the one who's turning on the light and applying the sensitizer. Because that actually changes the coding that's used.”

Bhatia also covered the topic of treating and identifying those who may be most at-risk with AK.

“I think everyone, regardless of skin type and color, should be getting their skin screened every year,” Bhatia said. “And the darker skin populations, whether they be Black, Asian, Hispanic, they're a little bit less at-risk of the development of actinic keratosis just based on the morphology and the carcinogenesis pathways. That being said, the more fair-skinned patients of skin types 1 to 3…are prone to UV damage.

He added that there is value in creating awareness among patients of all skin types that these spots are there and that skin cancer can happen to anybody.

“Obviously, we know Bob Marley passed from melanoma,” he noted. “Look at what happened with Jimmy Buffett. So again, the idea that skin cancer is for everyone, that's true. It's just more that we have to take into account, as far as who's at higher risk based on their stratification of the number of sunburns they have, how they respond to UV light, and then of course, if there's a strong family history of skin cancer.”

Bhatia added an important statistic which is that, regarding how many AKs can turn into squamous cell carcinoma, almost between 82 to nearly 100 squamous cell carcinomas have had some precursor from an actinic keratosis, which he concluded from different data sources.

“We have to be making the patients aware, don't sit on the spots,” he said. “Come in and get treated, come and get screened by a dermatologist, come get a regular checkup for anything you've had. And especially if you've had some sunburns, used tanning beds, or work outdoors, that might be 1 risk but now we have more risk.”

To learn more from Bhatia’s interview, watch the full video posted above.

The quotes contained in this summary were edited for clarity.