Updated: 4/11/2017

Actinic Keratosis

Review Topic
  • Keratotic, pre-malignant lesions
  • Epidemiology
    • common in fair-skinned individuals
    • common in elderly patients
    • results from significant lifetime sun exposure
      • keratinocyte damage
  • Associated conditions
    • may lead to squamous cell carcinoma 
  • Prognosis
    • typically slow-growing and persistent if untreated
  • Prognosis
  • Symptoms
    • typically asymptomatic
    • occasionally tender
  • Physical exam
    • thin, adherent transparent or yellow scale that progressively increases in thickness
    • often with telangiectasias
    • can progress to cutaneous horn 
      • difficult to distinguish from squamous cell carcinoma at this point
    • rough, “sand-paper” texture
      • often easier to detect by palpation rather than observation
    • frequently on sun-exposed areas
      • face, head, neck, dorsal hands, ears
  • Skin biopsy
    • dysplastic epidermis with keratinocyte atypia
      • hyperkeratotic cell with lower epithelial cells showing loss of polarity and hyperchromatic nuclei
      • no invasion into dermis
  • Squamous cell carcinoma
  • Actinic cheilitis
  • Lentigo maligna
  • Prevention
    • Annual follow-up for skin cancer monitoring
    • avoid sun exposure
    • use sunscreen
  • Lifestyle modification
    • avoid sun exposure
    • use sunscreen
  • Surgical
    • liquid nitrogen (cryotherapy) = most common treatment
    • electrodesiccation and curettage
  • Pharmacological
    • topical 5-fluorouracil
      • typically reserved for those with widespread actinic keratoses
  • Prognosis
    • typically slow-growing and persistent if untreated
  • Prevention
    • avoid sun exposure
    • use sunscreen
  • Complications
    • risk of progression to squamous cell carcinoma

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