The article by Dodson and colleagues is looking specifically at the question of the malignant potential of actinic keratoses (AKs) and whether or not treatment is justified in the prevention of morbidity and mortality due to squamous cell carcinoma (SCC). This discussion needs to be kept on that focus. It is not about whether or not AKs should be treated on the basis of symptoms, cosmetic appearance, or recent change, or merely because the patient does not want to have an abnormality. In these cases, there are other good reasons involved in the therapeutic decision, and the outcome is a matter between the patient and the physician. The treatment of AKs under these circumstances is justified and is part of overall patient care, not for preventing problems due to SCC.
To address whether we can justify the treatment of all AKs to prevent problems related to SCC, the cost (economic,
Marks R. The Role of Treatment of Actinic Keratoses in the Prevention of Morbidity and Mortality due to Squamous Cell Carcinoma. Arch Dermatol. 1991;127(7):1031-1033. doi:10.1001/archderm.1991.01680060105014