Identification of distinct dermatologist behavioral phenotypes in actinic keratosis management

Actinic keratoses (AKs) are premalignant lesions caused by sun exposure. Dermatologists may manage AKs using lesion-directed destruction or field-directed treatments, with demographic and practice-related factors potentially influencing treatment decisions. Using 2022 United States Medicare Provider Utilization and Payment data, we examined the AK treatment patterns of 9,912 general dermatologists. Premalignant lesion destructions, fluorouracil or imiquimod day-supplies, and skin cancer removals per 100 beneficiaries were standardized and entered into a K-means clustering algorithm, which identified three behavioral phenotypes: “more destruction” (12%), “more field treatment” (15%), and “both field treatment and destruction” (74%). Dermatologists in the "more destruction" group performed the highest volume of skin cancer removals, had the most years of practice, and had a higher proportion of male dermatologists. The “more field treatment” group had the fewest skin cancer removals. The “both field treatment and destruction” group had fewer years of practice. Geographic disparities were notable, with the South and West showing higher proportions of “more destruction.” Median income of the practice postal code, urban-rural status, and mean office visit level of service showed no meaningful differences between clusters. These findings demonstrate that dermatologist experience, gender, and region, but not socioeconomic practice factors, are associated with different AK management styles. This study illustrates the variation between dermatologists in their management of AKs. There may be opportunities to promote evidence-based AK management, particularly in regions or among providers underutilizing field treatments.