Non-melanoma Neoplasms

Abstract

Clinical: Actinic keratoses are considered pre-cancerous and present clinically as pink to erythematous, dry, gritty and scaly papules or plaques on the sun-exposed skin of older individuals. Frequently the face, helical ears, scalp, dorsal hand and forearms are most affected. Actinic keratoses appear more in men who burn easily (Fitzpatrick skin type I). Actinic cheilitis is the oral equivalent of AK presenting often on the middle portion of the lower lip as a painful scaly papule or plaque. Marked hyperkeratosis or cutaneous horns occur occasionally. It is thought that 0.1–10 % of all AKs progress into squamous cell carcinoma, although a small number likely regress on their own secondary to the immune response. Certain features are associated with greater risk of transformation into squamous cell carcinoma including inflammation, size greater than 1 cm, rapid growth, erythema, ulceration and bleeding. Several clinical variants of AKs exist including hyperplastic or hypertrophic AK (predominantly on dorsal hands or forearms), acantholytic AK (mimics BCC clinically), lichenoid AK (more red than typical AK) and pigmented AK (affecting mostly cheeks and forehead, which can be confused clinically with lentigo maligna due to AKs having associated lentigo). Cumulative lifetime sun damage appears to be the biggest risk factor for developing AKs.