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Z - Dermatology > Actinic Keratosis > Flashcards

Actinic Keratosis Flashcards

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Dermatology Board Prep flashcards
1
Q

What is actinic keratosis?

A

A pre-cancerous area of thick, scaly, or crusty skin

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2
Q

What is the underlying cause of actinic keratosis?

A

UV-induced DNA damage within the skin

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3
Q

How does sunlight cause DNA damage?

A

Photo-aging leads to an accumulation of oncogenic changes

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4
Q

What is the result of the oncogenic changes to skin cell DNA in actinic keratosis?

A

Proliferation of mutated keratinocytes that can manifest as actinic keratosis or other neoplastic growths

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5
Q

What are the three paths that actinic keratosis can take?

A
  • Remain stable
  • Progress to Bowen’s disease
  • Progress to SCC
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6
Q

What are the risk factors for actinic keratosis?

A
  • Fair skin
  • Immunosuppression
  • HPV
  • Balding
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7
Q

What are the signs of a person who would be considered fair skinned?

A
  • Freckling
  • Light hair and eye colour
  • Propensity to sunburn
  • Inability to tan
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8
Q

What is the typical morphology of actinic keratosis?

A

White, scaly plaque of variable thickness with surrounding redness

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9
Q

What is the typical size of actinic keratosis?

A

2-6mm (can be several cm)

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10
Q

Are actinic keratosis lesions usually symptomatic?

A

No

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11
Q

What are the uncommon presenting symptoms of an actinic keratosis lesion?

A
  • Tenderness
  • Itching
  • Bleeding
  • Stinging or burning sensation
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12
Q

What parts of the body to actinic keratosis develop on?

A

Those exposed to sunlight

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13
Q

What parts of the body are exposed to sunlight and thus at risk of actinic keratosis and other skin malignancies?

A
  • Face
  • Ears
  • Scalp
  • Forearms
  • Backs of hands
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14
Q

How does actinic keratosis feel on palpation with gloves?

A

Like sandpaper

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15
Q

Features of what may be seen around the actinic keratosis?

A

Solar damage

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16
Q

What are the features of solar damage that may be seen in actinic keratosis?

A
  • Notable pigmentary alterations
  • Deep wrinkles
  • Course texture of skin
  • Dry skin
  • Scattered telangiectasia
17
Q

What are the pigmentary alterations that can be seen around actinic keratosis?

A

Yellow or pale skin with some hyperpigmentation

18
Q

What are the different classifications of actinic keratosis?

A
  • Common
  • Hypertrophic
  • Atrophic
  • Cutaneous horn
  • Pigmented
  • Actinic chelitis
19
Q

What are the features of hypertrophic actinic keratosis?

A
  • Thicker scale

- Rough plaque/papule

20
Q

What are the features of atrophic actinic keratosis?

A
  • Lack of scale
  • Appears as a non-palpable change in colour
  • Smooth
  • Red
  • <10mm diameter
21
Q

What are the features of a cutaneous horn?

A
  • Keratinic projection
  • Height at least 1/2 of diameter
  • Conical shape
22
Q

What are the features of pigmented actinic keratosis?

A
  • Tan or brown

- Macules or papules

23
Q

How common is pigmented actinic keratosis?

A

It is a rare variant

24
Q

What is actinic chelitis?

A

When actinic keratosis forms on the lip

25
Q

Whit is actinic chelitis often accompanied by?

A

Sensation of a dry mouth and splitting of lips

26
Q

What appearance of actinic keratosis should raise suspicion of progression to malignancy?

A
  • Ulceration
  • Nodularity
  • Bleeding
27
Q

How is actinic keratosis usually diagnosed?

A

Clinically with a dermatoscope

28
Q

When is a skin biopsy used in actinic keratosis?

A

When there are features causing suspicion of malignancy

29
Q

What are the differentials for actinic keratosis?

A
  • BCC
  • SCC
  • Seborrhoeic keratosis
  • Bowen’s disease
  • Amelanotic melanoma
  • Discoid lupus erythematosis
30
Q

What are the general conservative management techniques for actinic keratosis?

A
  • Limit sun exposure
  • Use sun protection
  • Use emollients
  • Report changes to existing lesions
  • Report new lesions
31
Q

How can actinic keratosis be treated?

A
  • Topical treatments

- Ablative treatments

32
Q

What topical treatments are available for actinic keratosis?

A
  • 5FU cream

- Imiquimod cream

33
Q

What advice should be given when using topical treatments for actinic keratosis?

A

It may look worse before getting better

34
Q

What ablative therapies are available for actinic keratosis?

A
  • Cryoptherapy
  • Photodynamic therapy
  • Curettage or excision
35
Q

What is the type of treatment for actinic keratosis dependent on?

A
  • Clinical grade
  • Site
  • Number of lesions
  • Presence of field damage
  • Size of skin area affected
36
Q

What is cryotherapy useful for?

A

Single or multiple lesions without field damage

37
Q

What is photodynamic therapy useful for?

A

Individual lesions

38
Q

What is curettage or excisional surgery useful for?

A

Discrete hyperkeratotic lesions

39
Q

What is the important complication of actinic keratosis?

A

Progression to malignancy

Z - Dermatology (21 decks)

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