Updated: 1/27/2021

Actinic Keratosis

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Topic
Snapshot
  • A 60-year-old man with multiple "sun spots," or solar lentigos, comes to the dermatologist for his annual skin exam. He complains of several rough patches on his cheeks that has been there for a year. They feel like sandpaper. He is a gardener and often spent hours under the sun.
 
Introduction
  • Keratotic, pre-malignant lesions 
  • Epidemiology
    • common in fair-skinned individuals
    • common in elderly patients
    • results from significant lifetime sun exposure
      • keratinocyte damage
  • May lead to squamous cell carcinoma
Presentation
  • Symptoms
    • typically asymptomatic
  • Physical exam 
    • thin, adherent scale that is transparent or yellow
    • rough, “sand-paper” texture
    • may see some telangiectasias
    • frequently on sun-exposed areas
      • face, head, neck, dorsal hands, ears
Evaluation
  • Skin biopsy
    • dysplastic epidermis with keratinocyte atypia
    • no invasion into dermis
Differential
  • Squamous cell carcinoma
  • Actinic cheilitis
  • Lentigo maligna
Treatment
  • Lifestyle modification
    • avoid sun exposure
    • use sunscreen
  • Surgical
    • liquid nitrogen (cryotherapy) = most common treatment
  • Pharmacological
    • topical 5-fluorouracil
Prognosis, Prevention, and Complications
  • 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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Questions (3)
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(M1.MK.15.75) A 57-year-old male with a history of obesity, diabetes, and asthma presents to his primary care physician because he is concerned about recent changes to his skin. He says that he has noticed the skin around his neck and armpits appears to be darker as shown in Figure F. He is very concerned and asks the physician if these new changes could progress to skin cancer. The physician reassures the patient that they will not, but does state that other skin findings carry the risk of progressing to invasive squamous cell carcinoma. Which of the following images depict such a finding?

QID: 106752
FIGURES:
1

Figure A

13%

(22/163)

2

Figure B

2%

(4/163)

3

Figure C

3%

(5/163)

4

Figure D

6%

(9/163)

5

Figure E

75%

(122/163)

M 4 D

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Evidence (2)
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EXPERT COMMENTS (2)
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