To the Editor In their network meta-analysis (NMA) of treatments for actinic keratosis (AK), Steeb et al1 concluded that photodynamic therapy with aminolevulinate had the greatest long-term efficacy based on the surrogate outcome of complete clearance of AK at 12 months, followed by imiquimod cream, 5%, photodynamic therapy with methyl aminolevulinate, and cryosurgery. We expand on their concerns regarding clinical relevance of this ranking.