Field cancerization: Treatment

J Am Acad Dermatol. 2020 Sep;83(3):719-730. doi: 10.1016/j.jaad.2020.03.127. Epub 2020 May 6.

Abstract

The goal of field cancerization treatment is to reduce the risk of developing keratinocyte carcinoma. Selecting the appropriate therapy depends on the degree of field cancerization and the number of invasive cutaneous squamous cell carcinomas. Other considerations include treatment efficacy, cost, side effects, and patient preference. Field therapies are preferred because they address clinically visible disease and subclinical atypia. However, lesion-directed therapies are useful for lesions that are more difficult to treat or those where a histologic diagnosis is required. Patients with extensive field cancerization benefit from a combination of field-directed and lesion-directed treatments. The second article in this continuing medical education series provides a framework to guide evidence-based decision making for field cancerization treatment.

Keywords: actinic keratoses; cutaneous squamous cell carcinoma; field cancerization; keratinocyte carcinoma; solid organ transplant recipient.

Publication types

  • Review

MeSH terms

  • Administration, Cutaneous
  • Antineoplastic Combined Chemotherapy Protocols / pharmacology
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Calcitriol / analogs & derivatives
  • Calcitriol / pharmacology
  • Calcitriol / therapeutic use
  • Carcinogenesis / pathology
  • Carcinoma, Basal Cell / pathology
  • Carcinoma, Basal Cell / therapy*
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / therapy*
  • Clinical Decision-Making / methods
  • Combined Modality Therapy / methods
  • Cryosurgery / methods
  • Dermatology / methods
  • Drug Synergism
  • Evidence-Based Medicine / methods
  • Fluorouracil / pharmacology
  • Fluorouracil / therapeutic use
  • Humans
  • Injections, Intralesional
  • Keratosis, Actinic / pathology
  • Keratosis, Actinic / therapy*
  • Medical Oncology / methods
  • Mohs Surgery
  • Neoplasms, Second Primary / pathology
  • Neoplasms, Second Primary / therapy*
  • Photochemotherapy / methods
  • Randomized Controlled Trials as Topic
  • Skin / pathology
  • Skin Neoplasms / pathology
  • Skin Neoplasms / therapy*
  • Skin Pigmentation
  • Treatment Outcome
  • Ultraviolet Rays / adverse effects

Substances

  • calcipotriene
  • Calcitriol
  • Fluorouracil