Topical combined 5-fluorouracil and calcipotriene for actinic keratosis and superficial keratinocyte carcinoma: Modified Delphi expert panel guidelines from ITSCC.

Loranger, Nicole; Trepanowski, Nicole; Shah, Payal; Aizman, Leora; DeSimone, Jennifer; Cullison, Stephanie Jackson; Jafarian, Fatemeh; Ken, Kimberly M et al. · J Am Acad Dermatol · 2026

expert_opinion · Level V

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Abstract

Evidence on topical combined 5-fluorouracil/calcipotriene (5-FU/C) treatment of actinic keratoses (AKs), squamous cell carcinoma in situ (SCCIS), and superficial basal cell carcinoma is lacking. To develop an expert consensus regarding 5-FU/C treatment of AKs, SCCIS, and superficial basal cell carcinoma. Expert panelists were provided 5-FU/C literature review findings and survey results from International Immunosuppression and Transplant Skin Cancer Collaborative clinician members who prescribe 5-FU/C. Nine dermatologist/dermatologic surgeon International Immunosuppression and Transplant Skin Cancer Collaborative members with >5 years post-training experience or considerable clinical experience prescribing 5-FU/C participated in the panel. A 70% or higher concordance among respondents represented consensus. Key recommendations include: treating AKs with 5-FU/C twice daily for 4 to 5 days on the face/neck and 7 to 10 days on the scalp, trunk, and extremities; treating SCCIS with 5-FU/C twice daily for 7 to 10 days on the face/neck and 10 to 14 days on the scalp, trunk, and extremities; treating actinic cheilitis with 5-FU/C twice daily for 4 to 5 days; and no treatment modifications for patient immunosuppression. Small panel size and literature to date primarily including small, retrospective studies. Dermatologists may consider implementation of expert panel recommendations for treatment of AKs, SCCIS, and sBCC with 5-FU/C while awaiting larger, high-quality studies.