Actinic keratosis treatment options include which of the following?

• A. Refer to oculoplastics for 5-FU cream or excisional biopsy.
• B. Observation only.
• C. Oral antibiotics.
• D. Steroid cream.

Answer: (A)

Actinic keratosis on the eyelid or periocular region is a surface dysplasia that needs targeted treatment to remove abnormal cells and reduce cancer risk. Referring to oculoplastics is appropriate because these specialists understand the delicate anatomy around the eye and can supervise therapies or perform an excisional biopsy if a lesion looks suspicious for invasion. Topical 5-FU is a standard non-surgical option that selectively destroys rapidly dividing atypical keratinocytes, helping to clear the lesion while preserving surrounding tissue when used under expert guidance. Excisional biopsy serves both diagnostic and therapeutic roles by removing the lesion and providing a tissue sample to confirm there is no invasive cancer.

Observing the lesion alone isn’t suitable because actinic keratosis can progress to squamous cell carcinoma. Oral antibiotics don’t treat the dysplastic cells responsible for AK, and steroid cream addresses inflammation rather than the dysplasia and can even worsen skin thinning without addressing the underlying issue.