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Current perspective on actinic keratosis: a review
Author(s) -
Siegel J.A.,
Korgavkar K.,
Weinstock M.A.
Publication year - 2017
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.14852
Subject(s) - actinic keratosis , medicine , dermatology , field cancerization , keratosis , imiquimod , malignancy , dysplasia , carcinoma in situ , population , lentigo maligna , actinic keratoses , malignant transformation , skin cancer , photodynamic therapy , basal cell , carcinoma , cancer , pathology , melanoma , cancer research , environmental health , chemistry , organic chemistry
Summary Actinic keratoses ( AK s) are common, with prevalence in the U.S.A. estimated at almost 40 million in 2004 and annual costs of > $1 billion (U.S.D.). However, there is no universally accepted definition of AK and thus it is difficult to identify reliably. AK s are lesions of epidermal keratinocytic dysplasia that result from chronic sun exposure and have the ability to progress to invasive squamous cell carcinoma ( SCC ), but clinicians disagree about whether AK s are premalignant lesions, superficial SCC in situ or epiphenomena of chronically sun‐damaged skin. Yearly AK to SCC progression rates of 0·6% were reported in an elderly population with multiple prior keratinocyte carcinomas ( KC s); and rates of spontaneous AK regression have been reported to be > 50%, but regressed lesions often reappear. As AK s have both cosmetic consequences and potential for malignant transformation, there are multiple reasons for treatment. There is no current agreement on the most efficacious treatment, but 5‐fluorouracil has been shown to both prevent and treat AK s, and imiquimod and photodynamic therapy may have the best cosmetic outcomes. AK s may be treated to improve appearance and relieve symptoms, but the keratinocytic dysplasia that gives rise to malignancy, and sometimes appears as an AK , may be what actually threatens patient health. Thus, treatments should aim to decrease the risk of KC or facilitate KC diagnosis by reducing the potential for misidentification created when a KC appears in a field of AK s. Improved agreement among clinicians on AK definition may improve management.