Background: Topical anticancer agents such as 5-fluorouracil and imiquimod are widely prescribed in plastic and reconstructive surgery outpatient clinics for actinic keratoses and superficial non-melanoma skin cancers. Although clinical trials demonstrate high efficacy, real-world outcomes are frequently limited by poor adherence, unmanaged inflammatory reactions, and inconsistent follow-up, resulting in avoidable escalation to surgery and increased outpatient burden. Objective: To review contemporary evidence regarding models of care that improve adherence, complication surveillance, and cost-effectiveness in the delivery of topical anticancer therapy. Methods: A focused narrative review examined determinants of adherence, consultation duration and education, decentralised nurse-led and general-practice-based care, and digital health platforms supporting remote symptom monitoring and triage. Results: Inadequate pre-treatment counselling is strongly associated with non-adherence; one cross-sectional study reported that 46.9% of patients modified regimens independently, while longer consultations improved correct application. Nurse-led services provide structured education and routine surveillance, reducing hospital attendances. General practitioners offer scalable prescribing and early complication management, reserving specialist review for treatment failures. Digital platforms delivering automated self-management advice further reduce clinician workload and unscheduled reviews while improving patient confidence, supporting clinic capacity and cost-efficiency. Conclusion: Enhancing surgeon-led outpatient pathways through structured education, decentralised nurse- and GP-supported models, and telemedicine follow-up may improve adherence, mitigate complications, and reduce congestion in surgical clinics, optimising the real-world effectiveness of topical anticancer therapy.