Advertisement

Actinic Keratoses

  • Eggert Stockfleth
Part of the Cancer Treatment and Research book series (CTAR, volume 146)

Actinic keratoses (AKs) are defined as keratotic macules, papules, or plaques with superficial scale on a red base, occurring on areas extensively damaged by sunlight. They should be classified as in situ squamous cell carcinomas (SCC) [1, 2]. Histopathologically, an intraepidermal proliferation of atypical keratinocytes can be observed.

Keywords

Actinic Keratose Cutaneous Squamous Cell Carcinoma Invasive Squamous Cell Carcinoma Human Papilloma Virus Nonmelanoma Skin Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ackerman AB. Solar keratosis is squamous cell carcinoma. Arch Dermatol 2003; 139:1216–1217.PubMedCrossRefGoogle Scholar
  2. 2.
    Heaphy MR Jr, Ackerman AB. The nature of solar keratosis: a critical review in historical perspective. J Am Acad Dermatol 2000; 43:138–50.PubMedCrossRefGoogle Scholar
  3. 3.
    Brash DE, Ziegler A, Jonason AS, Simon JA, Kunala S, Leffell DJ. Sunlight and sunburn in human skin cancer: p53, apoptosis, and tumor protection. J Invest Dermatol Symp Proc 1996; 1:136–142.Google Scholar
  4. 4.
    Lober BA, Lober CW. Actinic keratosis is squamous cell carcinoma. South Med J 2000; 93:650–655.PubMedGoogle Scholar
  5. 5.
    Stockfleth E, Nindl I, Sterry W, Ulrich C, Schmook T, Meyer T. Human papillomaviruses in transplant-associated skin cancers. Dermatol Surg 2004; 30:604–609.PubMedCrossRefGoogle Scholar
  6. 6.
    Orth G, Jablonska S, Favre M, Jarzabek-Chorzelska M, Rzesa G. Characterization of two types of human papillomaviruses in lesions of epidermodysplasia verruciformis. Proc Natl Acad Sci USA 1978; 75:1537–1541.PubMedCrossRefGoogle Scholar
  7. 7.
    Harwood CA, Proby M. Human papillomaviruses and non-melanoma skin cancer. Curr Opin Infect Dis 2002; 15:101–114.PubMedGoogle Scholar
  8. 8.
    Jackson S, Storey A. E6 proteins from diverse cutaneous HPV types inhibit apoptosis in response to UV damage. Oncogene 2000; 19:592–598.PubMedCrossRefGoogle Scholar
  9. 9.
    Jackson S, Harwood C, Thomas M, Banks L, Storey A. Role of Bak in UV-induced apoptosis in skin cancer and abrogation by HPV E6 proteins. Genes Dev 2000; 14:3065–3073.PubMedCrossRefGoogle Scholar
  10. 10.
    Braakhuis BJM, Tabor MP, Kummer JA, Leemans CR, Brakenhoff RH. A genetic explanation of Slaughter’s concept of field cancerization: evidence and clinical implications. Cancer Res 2003; 63:1727–1730.PubMedGoogle Scholar
  11. 11.
    Callen JP, Bickers DR, Moy RL. Actinic keratoses. J Am Acad Dermatol 1997; 36:650–653.PubMedCrossRefGoogle Scholar
  12. 12.
    Mittelbronn MA, Mullins DL, Ramos-Caro FA, Klowers FP. Frequency of pre-existing actinic keratosis in cutaneous squamous cell carcinoma. Int J Dermatol 1998; 37:677–681.PubMedCrossRefGoogle Scholar
  13. 13.
    Ashton KJ, Weinstein SR, Maguire DJ, Griffiths LR. Chromosomal aberrations in squamous cell carcinoma and solar keratoses revealed by comparative genomic hybridization. Arch Dermatol 2003; 139:876–882.PubMedCrossRefGoogle Scholar
  14. 14.
    Memon AA, Tomenson JA, Bothwell J, Friedmann PS. Prevalence of solar damage and actinic keratosis in a Merseyside population. Br J Dermatol 2000; 142:1154–1159.PubMedCrossRefGoogle Scholar
  15. 15.
    Salasche SJ. Epidemiology of actinic keratoses and squamous cell carcinoma. J Am Acad Dermatol 2000; 42:4–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Frost C, Williams G, Green A. High incidence and regression rates of solar keratoses in a Queensland community. J Invest Dermatol 2000; 115:273–277.PubMedCrossRefGoogle Scholar
  17. 17.
    Schmook T, Stockfleth E. Current treatment patterns in non-melanoma skin cancer across Europe. J Dermatol Treat 2003; 14:S3–S10.CrossRefGoogle Scholar
  18. 18.
    Stockfleth E, Ulrich C, Meyer T, Christophers E. Epithelial malignancies in organ transplant patients: clinical presentation and new methods of treatment. Recent Results Cancer Res 2002; 160:251–258.PubMedGoogle Scholar
  19. 19.
    Ulrich C, Christophers E, Sterry W, Meyer T, Stockfleth E. Skin diseases in organ transplant patients. Hautarzt 2002; 53:524–533.PubMedCrossRefGoogle Scholar
  20. 20.
    Glogau R. The risk of progression to invasive disease. J Am Acad Dermatol 2000; 42:23–24.PubMedCrossRefGoogle Scholar
  21. 21.
    Berhane T, Halliday GM, Cooke B, Barnetson RSC. Inflammation is associated with progression of actinic keratoses to squamous cell carcinomas in humans. Br J Dermatol 2002; 146:810–815.PubMedCrossRefGoogle Scholar
  22. 22.
    Chung VQ, Dwyer PJ, Nehal KS, Rajadhyaksha M, Menaker GM, Charles C, Jiang SB. Use of ex vivo confocal scanning laser microscopy during Mohs surgery for nonmelanoma skin cancers. Dermatol Surg 2004; 30:1470–1478.PubMedCrossRefGoogle Scholar
  23. 23.
    Röwert-Huber J, Patel MJ, Forschner T, Ulrich C, Eberle J, Kerl H, Sterry W, Stockfleth E. Actinic keratosis is an early in situ squamous cell carcinoma: a proposal for reclassification. Br J Dermatol 2007; 156(Suppl 3):8–12.PubMedCrossRefGoogle Scholar
  24. 24.
    Guenthner ST, Hurwitz RM, Buckel LJ, Gray HR. Cutaneous squamous cell carcinomas consistently show histologic evidence of in situ changes: a clinicopathologic correlation. J Am Acad Dermatol 1999; 41:443–448.PubMedCrossRefGoogle Scholar
  25. 25.
    Ulrich C, Forschner T, Ulrich M, Stockfleth E, Sterry W, Termeer C. Management of actinic cheilitis using diclofenac 3% gel: a report of six cases. Br J Dermatol 2007; 156(Suppl 3):43–46.PubMedCrossRefGoogle Scholar
  26. 26.
    Emmett AJ, Broadbent GD. Shave excision of superficial solar skin lesions. Plast Reconstr Surg 1987; 80:47–54.PubMedCrossRefGoogle Scholar
  27. 27.
    Dinehart SM. The treatment of actinic keratoses. J Am Acad Dermatol 2000; 42:25–28.PubMedCrossRefGoogle Scholar
  28. 28.
    Coleman WP, Yarborough JM, Mandy SH. Dermabrasion for prophylaxis and treatment of actinic keratoses. Dermatol Surg 1996; 22:17–21.PubMedCrossRefGoogle Scholar
  29. 29.
    Drake LA, Ceiley R, Cornelison RL, Dobes WL, Dorner W, Goltz W, Graham G, Lewis CW, Salasche SJ, Chanco Turner ML, Lewery BJ. Guidelines of care for actinic keratoses. J Am Acad Dermatol 1995; 32:95–98.PubMedCrossRefGoogle Scholar
  30. 30.
    Zouboulis ChC. Principles of cutaneous cryosurgery: an update. Dermatology 1999; 198:111–117.PubMedCrossRefGoogle Scholar
  31. 31.
    Chiarello SE. Cryopeeling (extensive cryosurgery) for treatment of actinic keratoses: an update and comparison. Dermatol Surg 2000; 26:728–732.PubMedCrossRefGoogle Scholar
  32. 32.
    Szeimies RM, Radakovic S, Calzavara-Pinton PG, et al. A prospective, randomized study comparing photodynamic therapy with Metvix® to cryotherapy in actinic keratoses. J Eur Acad Dermatol Venereol 2000; 14:235.Google Scholar
  33. 33.
    Graham GF. Cryosurgery in the management of cutaneous malignancies. Clin Dermatol 2001; 19:321–327.PubMedCrossRefGoogle Scholar
  34. 34.
    Lubritz RR, Smolewski SA. Cryosurgery cure rate of actinic keratoses. J Am Acad Dermatol 1982; 7:631–632.PubMedCrossRefGoogle Scholar
  35. 35.
    Witheiler DD, Lawrence N, Cox SE, Cruz C, Cockerell CJ, Freeman RG. Long-term efficacy and safety of Jessner’s solution and 35% trichloroacetic acid vs. 5% fluorouracil in the treatment of widespread facial actinic keratoses. Dermatol Surg 1997; 23:191–196.PubMedCrossRefGoogle Scholar
  36. 36.
    Lawrence N, Cox SE, Cockerell CJ, Freeman RG, Cruz PD Jr. A comparison of the efficacy and safety of Jessner’s solution and 35% trichloroacetic vs. 5% fluorouracil in the treatment of widespread facial actinic keratoses. Arch Dermatol 1995; 131:176–181.PubMedCrossRefGoogle Scholar
  37. 37.
    Otley CC, Roenigk RK. Medium-depth chemical peeling. Semin Cutan Med Surg 1996; 15:145–154.PubMedCrossRefGoogle Scholar
  38. 38.
    Stone PA. The use of modified phenol for chemical face peeling. Clin Plast Surg 1998; 25:21–44.PubMedGoogle Scholar
  39. 39.
    Iyer S, Friedli A, Bowes L, Kricorian G, Fitzpatrick RE. Full face laser resurfacing: therapy and prophylaxis for actinic keratoses and non-melanoma skin cancer. Lasers Surg Med 2004; 34:114–119.PubMedCrossRefGoogle Scholar
  40. 40.
    Wollina U, Konrad H, Karamfilov T. Treatment of common warts and actinic keratoses by Er:YAG laser. J Cutan Laser Ther 2001; 3:63–66.PubMedCrossRefGoogle Scholar
  41. 41.
    Yu TC, Rahman Z, Ross BS. Actinic keratoses: surgical and physical therapeutic modalities. Cutis 2003; 71:381–4.PubMedGoogle Scholar
  42. 42.
    Fulton JE, Rahimi AD, Helton P, Dahlberg K, Kelly AG. Disappointing results following resurfacing of facial skin with Co2 lasers for prophylaxis of keratoses and cancers. Dermatol surg. 1999; 25:729–732.PubMedCrossRefGoogle Scholar
  43. 43.
    Szeimies RM, Karrer S, Radakovic-Fijan S, Tanew A, Calzavara-Pinton PG, Zane C, Sidoroff A, Hempel M, Ulrich J, Proebstle T, Meffert H, Mulder M, Salomon D, Dittmar HC, Bauer JW, Kernland K, Braathen L. Photodynamic therapy using topical methyl 5-aminolevulinate compared with cryotherapy for actinic keratosis: a prospective, randomized study. J Am Acad Dermatol 2002; 47:258–262.PubMedCrossRefGoogle Scholar
  44. 44.
    Morton CA, Brown SB, Collins S. Ibbotson S, Jenkinson H, Kurwa H, Langmack K, McKenna K, Moseley H, Pearse AD, Stringer M, Taylor DK, Wong G, Rhodes LE. Guidelines for topical photodynamic therapy: report of a workshop of the British Photodermatology Group. Br J Dermatol 2002; 146:552–567.PubMedCrossRefGoogle Scholar
  45. 45.
    Pariser DM, Lowe NJ, Stewart DM, Jarrat MT, Lucky AW, Pariser RJ, Yamauchi PS. Photodynamic therapy with topical methyl aminolevulinate for actinic keratosis: results of a prospective randomized multicenter trial. J Am Acad Dermatol 2003; 48:227–232.PubMedCrossRefGoogle Scholar
  46. 46.
    Freeman M, Vinciullo C, Francis D, Spelman L, Nguyen R, Fergin P, Thai KE, Murrell D, Weightman W, Anderson C, Reid C, Watson A, Foley P. A comparison of photodynamic therapy using topical methyl aminolevulinate (Metvix) with single cycle cryotherapy in patients with actinic keratosis: a prospective, randomized study. J Dermatolog Treat 2003; 14:99–106.PubMedCrossRefGoogle Scholar
  47. 47.
    Hemmi H, Kaisho T, Takeuchi O, Sato S, Sanjo H, Hoshino K, Horiuchi T, Tomizawa H, Takeda K, Akira S. Small anti-viral compounds activate immune cells via the TLR7 MyD88-dependent signaling pathway. Nat Immunol 2002; 3:196–200.PubMedCrossRefGoogle Scholar
  48. 48.
    Miller RL, Gerster JF, Owens ML, Slade HB, Tomai MA. Imiquimod applied topically: a novel immune response modifier and new class of drug. Int J Immunopharmacol 1999; 21:1–14.PubMedCrossRefGoogle Scholar
  49. 49.
    Stockfleth E, Meyer T, Benninghoff B, Salasche S, Papadopoulos L, Ulrich C, Christophers E. A randomized, double-blind, vehicle-controlled study to assess 5% imiquimod cream for the treatment of multiple actinic keratoses. Arch Dermatol 2002; 138:1498–1502.PubMedCrossRefGoogle Scholar
  50. 50.
    Stockfleth E, Christophers E, Benninghoff B, Sterry W. Low incidence of new actinic keratoses after topical 5% imiquimod cream treatment: a long-term follow-up study. Arch Dermatol 2004; 140:1542.PubMedCrossRefGoogle Scholar
  51. 51.
    Lebwohl M, Dinehart S, Whiting D, Lee PK, Tawfik N, Jorizzo J, Lee JH, Fox TL. Imiquimod 5% cream for the treatment of actinic keratosis: results from two phase III, randomized, double-blind, parallel group, vehicle-controlled trials. J Am Acad Dermatol 2004; 50:714–721.PubMedCrossRefGoogle Scholar
  52. 52.
    Johnson MP, Hageboutros A, Wang K, High L, Smith JB, Diasio RB. Life threatening toxicity in a dihydropyrimidin-dehydrogenase-deficiency patient after treatment with topical 5-fluorouracil. Clin Cancer Res 1999; 5:2006–2011.PubMedGoogle Scholar
  53. 53.
    Gupta AK. The management of actinic keratoses in the United States with topical fluorouracil: a pharmacoeconomic evaluation. Cutis 2002; 70:30–36.PubMedGoogle Scholar
  54. 54.
    Levy S, Furst K, Chern W. A comparison of the skin permeation of three topical 0.5% fluorouracil formulations with that of a 5% formulation. Clin Therapeutics 2001; 23:901–907.CrossRefGoogle Scholar
  55. 55.
    Jorizzo J, Stewart D, Bucko A, Davis A, Davis SA, Espy P, Hino P, Rodriguez D, Savin R, Stough D, Furst K, Connolly M, Levy S. Randomized trial evaluating a new 0.5% fluorouracil formulation demonstrates efficacy after 1-, 2-, or 4-week treatment in patients with actinic keratosis. Cutis 2002; 10:335–339.Google Scholar
  56. 56.
    Loven K, Stein L, Furst K, Levy S. Evaluation of the efficacy and tolerability of 0.5% fluorouracil cream and 5% fluorouracil cream applied to each side of the face in patients with actinic keratosis. Clin Ther 2002; 24:990–1000.PubMedCrossRefGoogle Scholar
  57. 57.
    Robins P, Gupta AK. The use of topical fluorouracil to treat actinic keratosis. Cutis 2002; 70:S4–S7.Google Scholar
  58. 58.
    Sass JO, Didierjean L, Carraux P, Plum C, Nau H, Saurat JH. Metabolism of topical retinaldehyde and retinol by mouse skin in vivo: predominant formation of retinyl esters and identification of 14-hydroxy-4,14-retro-retinol. Exp Dermatol 1996; 5:267–271.PubMedCrossRefGoogle Scholar
  59. 59.
    Sachsenberg-Studer EM. Tolerance of topical retinaldehyde in humans. Dermatology 1999; 199:S61–S63.CrossRefGoogle Scholar
  60. 60.
    Sorg O, Tran C, Saurat JH. Cutaneous vitamins A and E in the context of ultraviolet- or chemically-induced oxidative stress. Skin Pharmacol Appl Skin Physiol 2001; 14:363–372.PubMedGoogle Scholar
  61. 61.
    Moriarty M, Dunn J, Darragh A, Lambe R, Brick I. Etretinate in treatment of actinic keratosis. A double-blind crossover study. Lancet 1982; 13:364–365.CrossRefGoogle Scholar
  62. 62.
    Campanelli A, Naldi L. A retrospective study of the effect of long-term topical application of retinaldehyde (0.05%) on the development of actinic keratosis. Dermatology 2002; 205:146–152.PubMedCrossRefGoogle Scholar
  63. 63.
    Humphreys TR, Werth V, Dzubow L, Kligman A. Treatment of photodamaged skin with trichloroacetic acid and topical tretinoin. J Am Acad Dermatol 1996; 34:638–44.PubMedCrossRefGoogle Scholar
  64. 64.
    DiGiovanna JJ. Retinoid chemoprevention in patients at high risk for skin cancer. Med Pediatr Oncol 2001; 36:564–567.PubMedCrossRefGoogle Scholar
  65. 65.
    McNamara IR, Muir J, Galbraith AJ. Acitretin for prophylaxis of cutaneous malignancies after cardiac transplantation. J Heart Lung Transplant 2002; 21:1201–1205.PubMedCrossRefGoogle Scholar
  66. 66.
    Fecker LF, Stockfleth E, Nindl I, Ulrich C, Forschner T, Eberle J. The role of apoptosis in therapy and prophylaxis of epithelial tumours by nonsteroidal anti-inflammatory drugs (NSAIDs). Br J Dermatol 2007; 156(Suppl 3):25.PubMedCrossRefGoogle Scholar
  67. 67.
    Jung YJ, Isaacs JS, Lee S, Trepel J, Neckers L. IL-1β-mediated up-regulation of HIF-1α via an NFκB/COX-2 pathway identifies HIF-1 as a critical link between inflammation and oncogenesis. FASEB J 2003; 17:2115–2117.PubMedGoogle Scholar
  68. 68.
    Rivers JK, Arlette J, Shear N, Guenther L, Carey W, Poulin Y. Topical treatment of actinic keratoses with 3.0% diclofenac in 2.5% hyaluronan gel. Br J Dermatol 2002; 146:94–100.PubMedCrossRefGoogle Scholar
  69. 69.
    Gebauer K, Brown P, Varigos G. Topical diclofenac in hyaluronan gel for the treatment of solar keratoses. Aust J Dermatol 2003; 44:40–45.CrossRefGoogle Scholar
  70. 70.
    Wolf JE Jr, Taylor JR, Tschen E, Kang S. Topical 3.0% diclofenac in 2.5% hyaluronan gel in the treatment of actinic keratoses. Int J Dermatol 2001; 40:709–713.PubMedCrossRefGoogle Scholar
  71. 71.
    Armstrong BK, Kricker A. The epidemiology of UV induced skin cancer. J Photochem Photobiol B 2001; 63:8–18.PubMedCrossRefGoogle Scholar
  72. 72.
    Thompson SC, Jolley D, Marks R. Reduction of solar keratoses by regular sunscreen use. N Engl J Med 1993; 329:1147–1151.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Eggert Stockfleth
    • 1
  1. 1.Skin Cancer Center Charité, Department of DermatologyCharité – Universitätsmedizin BerlinGermany

Personalised recommendations