Cycling Cryotherapy, Topicals, and PDT for Actinic Keratosis Management

Neal Bhatia, MD, director of clinical dermatology at Therapeutic Clinical Research in San Diego, California, spoke with Dermatology Times about his sessions at Fall Clinical 2026. He covered comprehensive management of actinic keratosis, a new photodynamic therapy (PDT) indication for superficial basal cell carcinoma, and pitfalls in clinical research.

Sequencing Cryotherapy, Topicals, and PDT in Actinic Keratosis

Bhatia said comprehensive management of actinic keratosis has fallen short because many clinicians rely on liquid nitrogen rather than fight for medications. His lecture centered on sequencing cryotherapy with topical cycles and PDT, using either red or blue light.

“My whole theme was thinking in terms of ‘and’ instead of ‘or,’” Bhatia said.

He compared the approach to dating, freezing patients at the first visit to build trust before moving into a treatment cycle and then a routine.

Independent Study of Actinic Keratosis Cycle Therapy

Bhatia is running an independent study of freezing, topicals, and PDT. Patients have 4 to 12 actinic keratoses on the face or scalp and receive cryotherapy at the first visit. They are then randomized to 5 days of tirbanibulin ointment followed by 2 cycles of blue light PDT.

He is assessing lesion counts at the end of treatment, cosmetic indices, clearance, and tolerability. Bhatia said all patients so far are doing really well on therapy.

“Freezing and being done is not the only answer,” Bhatia said.

Red Light PDT for Superficial Basal Cell Carcinoma

Bhatia described the latest approval of aminolevulinic acid (ALA) 10% with red light for superficial basal cell carcinoma. Previous options focused more on squamous cell carcinoma in situ, for which both red and blue light are available. Blue light is also available for actinic keratosis.

He named the pretibial surfaces, behind the ears, and around the eyes as areas where surgery may be more difficult and red light PDT may fit. Superficial basal cell carcinomas also arise on the chest, face, legs, and extremities. Red light PDT can shrink the tumor or serve as monotherapy.

“This is a good option for patients who may not be surgical candidates,” Bhatia said.

Avoiding Pitfalls in Clinical Research

Bhatia also gave a lecture in the Mentoring for Leadership session on avoiding mistakes when incorporating clinical trials into practice. He said a busy clinic does not always translate into a busy research center, and overlooked nuances can affect enrollment and regulatory requirements. Some attendees told him the lecture scared them straight, but he encouraged them not to be discouraged.

“It’s about just being accurate, being prompt, and being set up for success in a research trial unit,” Bhatia said.

Bhatia advised starting with case reports or an independent phase 4 study, then moving to lighter phase 3 trials, with phase 1 and phase 2 work as a golden opportunity for dermatologists. “Just start slowly, like we all do, and learn from our mistakes, but try not to make too many of them,” he said.