Actinic keratosis

Question 1

Define actinic keratosis

Answer 1

Sun-induced scaly or hyperkeratotic lesion, which has the potential to become malignant.

Question 2

Aetiology and risk factors for actinic keratoses

Answer 2

Cumulative long-term sun-exposure

> 45yo
Xeroderma pigmentosum
Albinism
Fair skin
Blue eyes
Blonde hair
Artificial UV radiation
Male sex

Question 3

Features of actinic keratoses

Answer 3

Skin lesions:
- Head, neck, forearms, hands
- Rough surface scale
- White/pink/brown
- Flat
Significant sun-damaged skin with pigment irregularity, telangiectasia, erythema and collagenosis (a yellow papularity of the skin)

Question 4

Investigations for actinic keratosis

Answer 4

Dermoscope:
White-yellow scale
A red pseudonetwork giving a strawberry-like appearance
Occasionally ‘rosette-like’ structures comprised of four grouped dots/globules (clods), best seen under polarised light
Structures may not be visible if there is a lot of scale

Biopsy: Partial thickness atypia, parakeratosis

Question 5

Management for actinic keratosis

Answer 5

Consider 2ww (?SqCC)

Thorough skin examination
Education about sun exposure + observe
Moisturiser

Lesion-specific treatment:
Topical
- Efudix cream (5-fluorouracil)
- Klisyri cream (tirbanibulin)
- Actikerall solution
- Imiquimod
Localised:
- Cryotherapy
- Photodynamic therapy

Question 6

Prognosis for actinic keratosis

Answer 6

Risk of transformation into squamous cell carcinoma is very low
The presence of ten AK is associated with a 14% risk of developing an SCC within five years.