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Updated: 6/22/2021

Actinic Keratosis

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  • Summary
    • Actinic Keratosis is an epidermal pre-malignant lesion caused by sun exposure that may predispose to squamous cell carcinoma of the skin.
    • Diagnosis is made with a biopsy showing hyperkeratotic cells and lower epithelial cells showing loss of polarity and hyperchromatic nuclei
    • Treatment is usually cryotherapy. 
  • Epidemiology
    • Demographics
      • common in fair-skinned individuals
      • common in elderly patients
    • Risk factors
      • results from significant lifetime sun exposure
        • keratinocyte damage
  • Etiology
    • Associated conditions
      • may lead to squamous cell carcinoma
  • Presentation
    • 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
  • Evaluation
    • Skin biopsy
      • dysplastic epidermis with keratinocyte atypia
        • hyperkeratotic cell with lower epithelial cells showing loss of polarity and hyperchromatic nuclei
        • no invasion into dermis
  • Differential
    • Squamous cell carcinoma
    • Actinic cheilitis
    • Lentigo maligna
  • Treatment
    • 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
  • Complications
    • Prognosis
      • typically slow-growing and persistent if untreated
    • Prevention
      • avoid sun exposure
      • use sunscreen
    • Complications
      • risk of progression to squamous cell carcinoma
  • Prognosis
    • Typically slow-growing and persistent if untreated

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