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Actinic Keratosis

  • Allison Pye
  • Daniel Wallis
  • Vineet Mishra
Chapter

Abstract

Actinic keratosis (AK) is the most common precancerous skin lesion. AKs present on sun-damaged skin as pink to red gritty macules or papules. Patients with numerous AKs are at increased risk of developing skin cancer. AK development represents the initial step in keratinocytes’ progression to squamous cell carcinoma. Patients with numerous AKs are at increased risk of developing skin cancer. Treatment options for AKs include cryosurgery, topical chemotherapies, chemical peels, and laser surgery. Prevention is of utmost importance, including photoprotection such as sun protective clothing and sunscreens.

Keywords

Actinic keratosis Solar keratosis Photodamage Precancerous Cryosurgery Topical chemotherapy Sun protection 

References

  1. 1.
    Rosen T, Lebwohl MG. Prevalence and awareness of actinic keratosis: barriers and opportunities. J Am Acad Dermatol. 2013;68(1):S2–9.CrossRefPubMedGoogle Scholar
  2. 2.
    James WD, Elston DM, Berger TG, Elston DM. Epidermal nevi, neoplasms, and cysts. In: James WD, Berger TG, Elston DM, editors. Andrews' diseases of the skin. 12th ed. Philadelphia: Elsevier; 2016.Google Scholar
  3. 3.
    Chen GJ, Feldman SR, Williford PM, Hester EJ, Kiang S-H, Gill I, et al. Clinical diagnosis of actinic keratosis identifies an elderly population at high risk of developing skin cancer. Dermatol Surg. 2005;31(1):43–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Dodson JM. Malignant potential of actinic keratoses and the controversy over treatment. A patient-oriented perspective. AMA Dermatol. 1991;127(7):1029–31.CrossRefGoogle Scholar
  5. 5.
    Roewert-Huber J, Stockfleth E, Kerl H. Pathology and pathobiology of actinic (solar) keratosis - an update. Br J Dermatol. 2007;157(s2):18–20.CrossRefPubMedGoogle Scholar
  6. 6.
    Nair PA, Chaudhary AH, Mehta MJ. Actinic keratosis underlying cutaneous horn at an unusual site— a case report. E Cancer Med Sci. 2013;7:376.Google Scholar
  7. 7.
    Soyer HP, Rigel DS, Wurm EMT. Actinic keratosis, basal cell carcinoma and squamous cell carcinoma. In: Bolognia J, Jorizzo JL, Schaffer JV, editors. Dermatology. 3rd ed. Philadelphia: Elsevier; 2012.Google Scholar
  8. 8.
    Zalaudek I, Ferrara G, Leinweber B, Mercogliano A, D'Ambrosio A, Argenziano G. Pitfalls in the clinical and dermoscopic diagnosis of pigmented actinic keratosis. J Am Acad Dermatol. 2005 Dec;53(6):1071–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Bagazgoitia L, Cuevas J, Expression JA. Of p53 and p16 in actinic keratosis, bowenoid actinic keratosis and Bowen's disease. J Eur Acad Dermatol Venereol. 2005;24(2):228–30.CrossRefGoogle Scholar
  10. 10.
    Rowert-Huber J, Patel MJ, Forschner T, Ulrich C, Eberle J, Kerl H, et al. Actinic keratosis is an early in situ squamous cell carcinoma: a proposal for reclassification. Br J Dermatol. 2007;156(3):8–12.CrossRefPubMedGoogle Scholar
  11. 11.
    Werner RN, Stockfleth E, Connolly SM, Correia O, Erdmann R, Foley P, et al. Evidence- and consensus-based (S3) guidelines for the treatment of actinic keratosis - international league of dermatological societies in cooperation with the European dermatology forum - short version. J Eur Acad Dermatol Venereol. 2015;29(11):2069–79.CrossRefPubMedGoogle Scholar
  12. 12.
    Trost LB, Bailin PL. Cryosurgery. In: Vidimos AT, Ammirati CT, Poblete-Lopez C, editors. Dermatologic surgery. Philadelphia: Elsevier; 2009.Google Scholar
  13. 13.
    Kuflik EG, Kuflik JH. Cryosurgery. In: Bolognia JL, Jorizzo JL, Schaffer JV, editors. Dermatology. 3rd ed. Philadelphia: Elsevier; 2012.Google Scholar
  14. 14.
    Pomerantz H, Hogan D, Eilers D. Long-term efficacy of topical fluorouracil cream, 5%, for treating actinic keratosis. JAMA Dermatol. 2015;151(9):952–60.CrossRefPubMedGoogle Scholar
  15. 15.
    Askew DA, Mickan SM, Soyer HP, Wilkinson D. Effectiveness of 5-fluorouracil treatment for actinic keratosis – a systemic review of randomized controlled trials. Int J Dermatol. 2009;48(5):453–63.CrossRefPubMedGoogle Scholar
  16. 16.
    Ritchie SA, Patel MJ, Miller SJ. Therapeutic options to decrease actinic keratosis and squa- mous cell carcinoma incidence and progression in solid organ transplant recipients: a practical approach. Dermatol Surg. 2012 May;38(10):1604–21.CrossRefPubMedGoogle Scholar
  17. 17.
    Hanna E, Abadi R, Abbas O. Imiquimod in dermatology: an overview. Int J Dermatol. 2016;55(8):831–44.CrossRefPubMedGoogle Scholar
  18. 18.
    Stockfleth E. Lmax and imiquimod 3.75%: the new standard in AK management. J Eur Acad Dermatol Venereol. 2015;29(Supp.1):9–14.CrossRefPubMedGoogle Scholar
  19. 19.
    Ulrich C, Bichel J, Euvrard S, Guidi B, Proby CM, et al. Topical immunomodulation under systemic immunosuppression: results of a multicentre, randomized, placebo-controlled safety and efficacy study of imiquimod 5% cream for the treatment of actinic keratosis in kidney, heart, and liver transplant patients. Br J Dermatol. 2007;157(Suppl 2):25–31.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Jenkins SN, Speck K, Actinic CSC. Keratosis and bowen’s disease. In: Bigby M, Herxheimer A, editors. Evidence based dermatology. 3rd ed. Chichester, England: Wiley-Blackwell; 2014.Google Scholar
  21. 21.
    Gold MH. Lasers, photodynamic therapy, and the treatment of medical dermatological conditions. In: Goldberg DJ, editor. Laser dermatology. New York: Springer Publishing; 2005.Google Scholar
  22. 22.
    Hantash BM, Stewart DB, Cooper ZA. Facial resurfacing for nonmelanoma skin cancer prophylaxis. Arch Dermatol. 2006;142(8):976–82.CrossRefPubMedGoogle Scholar
  23. 23.
    Iyer SS, Friedli A, Bowes L, Kricorian G. Full face laser resurfacing: therapy and prophylaxis for actinic keratosis and non-melanoma skin cancer. Lasers Surg Med. 2004;34(2):114–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Criscione VD, Weinstock MA, Naylor MF, Luque C, Eide MJ, Bingham SF, Department of Veterans Affairs Topical Tretinoin Chemoprevention Trial Group. Natural history and risk of malignant transformation in the veterans affairs topical Tretinoin chemoprevention trial. Cancer. 2009;115(11):2523–30.CrossRefPubMedGoogle Scholar
  25. 25.
    Quaedvlieg PJ, Tirsi E, Thissen MR, Krekels GA. Actinic keratosis: how to differentiate the good from the bad ones? Eur J Dermatol. 2006;16(4):335–9.PubMedGoogle Scholar
  26. 26.
    Madigan LM, Lim HW. Tanning beds: impact on health, and recent regulations. Clin Dermatol. 2016;34(5):640–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Nikolaou V, Stratigos AJ, Tsao H. Hereditary nonmelanoma skin cancer. Semin Cutan Med Surg. 2012;31(4):204–10.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Naylor MF, Boyd A, Smith DW, Cameron GS, Hubbard D, Neldner KH. High sun protection factor sunscreens in the suppression of actinic neoplasia. Arch Dermatol. 1995;131(2):170–5.CrossRefPubMedGoogle Scholar
  29. 29.
    Darlington S, Williams G, Neale R, Frost C, Green A. A randomized controlled trial to assess sunscreen application and beta carotene supplementation in the prevention of solar keratoses. Arch Dermatol. 2003;139(4):451–5.CrossRefPubMedGoogle Scholar
  30. 30.
    Thompson SC, Jolley D, Marks R. Reduction of solar keratoses by regular sunscreen use. N Engl J Med. 1993;329(16):1147–51.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.DermatologyMcGovern Medical School, UT HoustonHoustonUSA
  2. 2.DermatologyTexas Tech University Health Sciences CenterLubbockUSA
  3. 3.Department of MedicineUniversity of Texas Health Science Center – San AntonioSan AntonioUSA

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