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Actinic keratosis
See also in: External and Internal Eye,Hair and Scalp
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Actinic keratosis

See also in: External and Internal Eye,Hair and Scalp
Print Patient Handout Images (114)
Contributors: Rajini Murthy MD, Vivian Wong MD, PhD, Elyse M. Love MD, Sarah Hocker DO, Susan Burgin MD
Other Resources UpToDate PubMed

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Synopsis

Actinic keratosis : Sun-exposed distribution
Actinic keratoses (AKs) are considered precancerous lesions and present as rough, scaly macules or patches arising on chronically sun-exposed skin. This is a very common condition in individuals with lighter skin colors and is virtually unseen in people with darker skin colors. AKs are commonly seen on sun-exposed skin of the face, ears, scalp (areas of hair loss), neck, upper chest, forearms, dorsal hands, shins, and, less commonly, the eyelids and periocular region. These flat, scaly papules are of varying sizes and usually begin as "rough" localized skin lesions that the patient feels but are difficult to see. They are usually asymptomatic but may be tender.

The frequency of AKs increases with age and cumulative lifetime sun exposure. They are also more common in individuals who are immunosuppressed (especially after solid organ transplantation) and in males. They may resolve with protection from ultraviolet (UV) light. Some medications (ie, capecitabine, sorafenib) may induce inflammation of existing AKs.

Patients with AKs are at higher risk for developing nonmelanoma skin cancer. AKs have the potential to evolve into squamous cell carcinoma (SCC). It is estimated that the likelihood that a given AK will evolve into an invasive SCC is approximately 0.075%-0.096% per lesion.

The term "field cancerization" is used to describe areas of skin at risk for both AK and SCC. Clinically, this manifests as numerous AKs and squamous cell carcinoma in situ (SCCis) with or without invasive SCCs in a field of chronically sun-damaged skin. Risk factors include male sex, lighter skin color, older age, underlying immunosuppression, and the degree of prior exposure to UV light.

Related topic: actinic cheilitis

Codes

ICD10CM:
L57.0 – Actinic keratosis

SNOMEDCT:
201101007 – Actinic keratosis

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:12/18/2021
Last Updated:02/10/2022
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Actinic keratosis
See also in: External and Internal Eye,Hair and Scalp
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Actinic keratosis : Sun-exposed distribution
Clinical image of Actinic keratosis
An adherent mound of scale atop a thin pink plaque.

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