
The JCMS Dermatology Podcast with Dr Kirk Barber
Episode 104: Treating the Field: Dr. Steven Feldman on Sun Damage and Actinic Keratoses
“There’s probably a whole field that’s been affected by the sun and the resulting DNA damage.” An actinic keratosis may appear to be an isolated lesion—but it can also signal a much larger field of sun-damaged, precancerous skin. Dr. Kirk Barber speaks with Dr. Steven Feldman about field cancerization and how its size should influence the treatment of actinic keratoses. They discuss the difference between treating individual lesions and an entire field, the role of topical therapies, and whether approved treatment limits reflect the much larger areas of precancerous change dermatologists encounter in clinical practice. They also consider how clinicians balance cancer prevention against treatment discomfort, patient age, overall health and the relatively low risk of an individual actinic keratosis progressing to skin cancer. Their wide-ranging conversation explores the difficulty of clinically defining a field, the cumulative effects of sun damage, the potential cosmetic benefits of field therapy and the need for a more nuanced approach to sun protection. The conversation is based on the JCMS article “The Characterization of the Relationship Between Field Cancerization and the Number of Actinic Keratoses.” Dr. Steven Feldman is a professor of dermatology, pathology, social sciences and health policy at Wake Forest University School of Medicine in North Carolina. He also leads the Center for Dermatology Research. For more on the treatment of actinic keratoses, listen to Episode 82 of JCMS Author Interviews, featuring Dr. Christopher Chew and an Australian perspective on managing the condition. Dr. Barber and his guest do not receive any financial reimbursement for the production of this podcast. For more great CDA podcasts, check out Dermalogues, our residents podcast hosted by Dr. Kerri Purdy. To learn more about the work of the Canadian Dermatology Association, please visit our website at dermatology.ca. This podcast is produced by David McGuffin and Graham McGuffin of ExploreProductions.ca

