Laser and chemical resurfacing as field treatment for actinic keratoses: a systematic review of the literature

Laser resurfacing and chemical peels have emerged as options for the field treatment of actinic keratoses (AKs). We aimed to evaluate the efficacy of lasers and chemical peels for field treatment of AKs and prevention of non-melanoma skin cancer (NMSC). A PubMed search of all relevant literature describing the use of laser resurfacing and chemical peels as field treatment in AK management or NMSC prevention was performed. Articles published through February 15, 2025, were included. Fifty-three unique studies evaluating laser and chemical resurfacing alone, or in combination with other treatments, for the treatment of AKs were identified; 45 focused on laser resurfacing and nine on chemical peels. Fifteen studies evaluated either recurrence of AKs or progression to NMSC. Combination therapies using ablative lasers with photodynamic therapy had the greatest clearance of AKs, and ablative lasers alone were more effective than non-ablative lasers. Chemical peels exhibited a more tolerable side effect profile but were less effective in treating AKs. Further studies are needed to optimize procedural protocols and evaluate long-term outcomes, including recurrence of AKs and progression to NMSC, following these field treatments.