Actinic keratosis

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Summary of Actinic keratosis

Actinic keratosis is a pre-cancerous patch of thick, scaly, or crusty skin. These growths are more common in fair-skinned people and those who are frequently in the sun. They usually form when skin gets damaged by ultraviolet radiation. Actinic keratosis is considered potentially pre-cancerous. Untreated lesions have up to a 20% risk of progression to squamous cell carcinoma, so treatment by a dermatologist is recommended.

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Actinic keratosis

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NOTES NOTES BURNS & FROSTBITE GENERALLY, WHAT ARE THEY? PATHOLOGY & CAUSES ▪ Damage to skin, underlying structures due to overexposure to harmful conditions ▪ Burn/frostbite injury → loss of skin function ▫ Impaired thermoregulation → loss of body heat ▫ Impaired ﬂuid retention → large water, protein losses from skin, affected tissues ▫ Loss of microbial barrier function → high risk of infection SIGNS & SYMPTOMS ▪ Pain, erythema, blistering, skin layers slough off DIAGNOSIS OTHER DIAGNOSTICS ▪ Clinical presentation ▫ Nature of exposure, appearance of wound, depth of damage TREATMENT MEDICATIONS ▪ Analgesia SURGERY ▪ Debridement of dead tissue ACTINIC KERATOSIS osms.it/actinic_keratosis PATHOLOGY & CAUSES ▪ Repeated prolonged sun exposure → small, ill-deﬁned, rough, scaly patches of skin ▪ Once initial lesions develop, more may follow without additional sun exposure ▪ UVB radiation → damage to keratinocytes → accumulation of oncogenic changes (e.g. p53 gene mutation) → unchecked proliferation of dysplastic keratinocytes → precancerous lesion RISK FACTORS ▪ Fair-skinned individuals; facial distribution, sun-exposed limbs; increased age; immunosuppression; albinism; xeroderma pigmentosum; human papillomavirus (HPV) infection COMPLICATIONS ▪ Malignant transformation to squamous cell carcinoma (0.03–20% likelihood) SIGNS & SYMPTOMS ▪ Small, rough, scaly skin lesions ▪ Sandpaper-like sensation felt on palpation ▪ Induration, tenderness, bleeding → possible malignant transformation OSMOSIS.ORG 1

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Actinic keratosis

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A 70-year-old man comes to the office because of a lesion on his forehead. He is a roofer who first noticed it about two months ago. He has hypertriglyceridemia and hypertension, for which he takes simvastatin and hydrochlorothiazide, respectively. Physical examination shows a rough erythematous patch adjacent to his hairline. A biopsy of the lesion is performed and shows hyperkeratosis and parakeratosis within the epidermis, as seen below. Which of the following cancers is this patient at an increased risk of developing?

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