Video Blog: Field Cancerization

Dr. Cornejo walks us through Field Cancerization from her lecture on Saturday, November 11, 2023, at the 4th Annual Elevate-Derm PA/NP Conference in Coachella Valley, CA.

In this video

In this interview with dermatology PA Lisa Weiss, Dr. Cornejo explains why recognizing field cancerization matters: these patients are at risk for multiple skin cancers and poor disease-related outcomes if the field isn't managed aggressively. For treatment-naive patients, she prefers 5-fluorouracil as monotherapy over the combination with calcipotriene, because the time to inflammation is slower, it causes fewer symptoms early on, and it's easier for patients to accept — and if they become too symptomatic, things calm down faster than with the combo approach.

On counseling, Dr. Cornejo finds it helps to make the reaction sound worse than it will be so patients stick with the course; when she undersells it, they're more likely to stop. She tells them the worst that happens is repeating the treatment if they don't get the expected outcome. Above all, she stresses an open discussion upfront — field therapy is a lifelong treatment, not a one-time fix — and tailoring the plan to each patient, whether that's a cream at home, in-office photodynamic therapy, or a lesion-directed approach if that's their preference.

• Recognize field cancerization early — these patients are at risk for multiple skin cancers and poor outcomes without aggressive management.
• For treatment-naive patients, consider 5-FU monotherapy over the calcipotriene combo: slower time to inflammation, fewer early symptoms, and quicker to calm down if patients become too symptomatic.
• Set expectations upfront and tell patients to send a photo and take a break if they're more than a little uncomfortable — the worst case is simply repeating the treatment.
• Counsel that field therapy is a lifelong process, not a one-time fix.
• Tailor the plan to the individual — at-home cream, in-office photodynamic therapy, or lesion-directed treatment based on what the patient is able and willing to do.