Io the editor: The article in American Family Physician is a comprehensive review of the available therapeutic options for patients with actinic keratoses. Although the article illustrates useful recommendations for actinic keratoses, we would like to make some clarifications and suggest further treatments. Actinic cheilitis is a clinical variant of actinic keratoses developing typically on the lower lip (the mote sun-exposed area), which has a greater risk of progression to invasive squamous cell carcinoma compared with normal skin. Early actinic, keratotic lesions of the lips may have a tough contour and/or appear slightly white (milky discoloration). More advanced lesions appear erythematous, thickened, and may show fissuring, scaliness, or ulcer ations (Figure 1A) with loss of the vermilion border. Any suspicious thickened, ulcerated, or cryotherapy-resistant lesions should be biopsied first; we advise using the shave technique to avoid scarring.
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