Case 1 - Actinic Keratosis PWQ Flashcards
What is actinic keratosis?
Actinic keratosis is a scaly spot found on sun-damaged skin. It is also known as solar keratosis. It is considered precancerous or an early form of cutaneous squamous cell carcinoma (a keratinocyte cancer).
Explain how UV light affects the skin
UVB can cause skin cancer by damaging P53 tumour suppressor genes involved in DNA repair or by activating cancer-promoting genes (oncogenes). UVA penetrates the skin more deeply and is involved in the carcinogenesis of skin stem cells.
Explain the effect of UV light on the different types of skin
Pale or white skin burns easily and tans slowly and poorly: it needs more protection against sun exposure. Darker skin burns less and tans more easily. It is also more prone to develop postinflammatory pigmentation after injury (brown marks).
Explain the ABCDE criteria that may indicate a suspicious lesion.
○ A = Asymmetry ○ B = Border irregularity ○ C = Colour variation ○ D = Diameter greater than 6mm ○ E = Evolution
4.) What would you do as a pharmacist if you suspected that Joseph had cancerous or pre-cancerous skin lesions? Include to whom you might refer and why?
Discuss with Joseph about his symptoms, lifestyle, concerns, etc. in an attempt to gain an understanding of his condition - without alarming him.
Some key questions that can be asked to further investigate whether or not his skin lesion is malignant or not could be:
○ How long has it been there?
○ Have you noticed any changes in size, shape or colour?
○ Does this mole appear different to the others that you have?
Depending on the information received, it may be appropriate to refer Joseph to an appropriate specialist.
What are sunscreens/sunblocks? Explain the SPF rating and how this might influence the choice of product.
Sunscreens are topical formulations used to protect the skin against UV radiation which damages the skin. SPF stands for ‘sun protection factor’ and indicates how much longer we could expect to be exposed to UVB before burning compared to if no sunscreen was applied.
What are the different formulations of sunscreen? Discuss the advantages and disadvantages of the different formulations.
Chemical agents - absorb UV rays and convert them into heat, then release the heat from the skin.
■ Pros - less product is needed to offer protection
■ Cons - requires time, can exacerbate sensitive skin conditions
Physical agents - sit on top of the skin and act as physical blockers by deflecting and scattering UV light away from the skin.
■ Pros - immediate, does not clog pores, effective against UVA & UVB
■ Cons - frequent application needed, leaves white cast over skin
Discuss the differential diagnosis of Actinic Keratosis
Squamous cell carcinoma - determined by peripheral white around central scaly core.
Psoriasis - red, scaly plaques. Scaly skin whiter in psoriasis vs. yellow in AK.
