Actinic keratosis

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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 55-year-old man comes to the office for evaluation of scaliness and redness over his forehead for the past few months. It sometimes causes a stinging sensation on the affected area. Review of systems is noncontributory. He has been working as a lifeguard at the beach for the past 25 years. Past medical history is significant for type 2 diabetes mellitus that is well-controlled with metformin. Temperature is 37.0°C (98.6°F), pulse is 78/min, respirations are 16/min, and blood pressure is 126/75 mmHg. Physical examination reveals a sandpaper-like texture of the forehead on palpation. An image of the lesion is shown below:

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Which of the following is the most likely diagnosis?

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