Curettage combined with photodynamic therapy to treat for field cancerization of extensive actinic keratosis on the scalp and face.

The excellent efficacy and safety of 5-ALA PDT combined with curettage was achieved.

The simplicity, efficiency, cost and side effects of this method make it suitable for promotion in community clinic and dermatologists.

Actinic keratosis (AK) frequently manifests as multiple regional lesions on the exposed areas of the face and scalp. The simultaneous treatment of extensive lesions with varying degrees poses a significant challenge.

This study evaluated the efficacy and patient satisfaction of 5-aminolevulinic acid (5-ALA) photodynamic therapy (PDT) combined with curettage in managing extensive AK on the face and scalp.

A retrospective analysis was conducted on patients with AK on the face and scalp treated at the dermatology department of a large hospital in a central Chinese city from 2020 to 2024. Each patient was histopathologically confirmed, exhibited a large lesion area exceeding 10 cm², and demonstrated evident field cancerization. All patients underwent curettage followed by 5-ALA PDT. During a 6-month follow-up, patient self-assessment and physician evaluations were conducted to systematically assess the treatment's efficacy, satisfaction, and adverse reactions.

Fifty-six patients (38 females, 18 males) with a mean age of 76.26±9.16 years were included. Significant improvement in skin was observed, with the lesion count decreasing from 12.33±9.09 pretreatment to 1.98±1.50 post-treatment. Pain scores (VAS) decreased from 2.89±2.20 to 0.75±1.03, pruritus scores (NAS) from 2.46±0.95 to 0.51±0.73, and dermatology life quality index (DLQI) scores from 9.12±4.46 to 2.59±2.17. The primary adverse effect was pain during PDT.

Curettage combined with 5-ALA PDT is an efficacious, safe, and efficient treatment for field cancerization of extensive AK on the face and scalp, warranting its promotion in clinical practice.

Photodynamic therapy

Curettage

Actinic keratosis

Field cancerization

© 2025 The Authors. Published by Elsevier B.V.