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Actinic keratosis

See also in: External and Internal Eye,Hair and Scalp
Contributors: Vivian Wong MD, PhD, Elyse M. Love MD, Sarah Hocker DO, Susan Burgin MD
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Synopsis

Actinic, or solar, keratosis (AK) is a neoplastic condition in which precancerous epithelial lesions are found on sun-exposed areas of the body. This is a very common condition in individuals with lighter skin phototypes and is virtually unseen in people with darker skin phototypes. Actinic keratoses are commonly seen on sun-exposed skin of the face, scalp (where balding), 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 actinic keratoses increases with age and cumulative lifetime sun exposure. They are also more common in immunosuppressed individuals (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 actinic keratoses.

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

The term "field cancerization" is used to describe areas of skin at risk for both actinic keratosis and squamous cell carcinoma. 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 phototype, older age, underlying immunosuppression, and the degree of prior exposure to ultraviolet 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:10/14/2020
Last Updated:11/03/2020
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Actinic keratosis
See also in: External and Internal Eye,Hair and Scalp
Actinic keratosis : Sun-exposed distribution
Clinical image of Actinic keratosis
An adherent mound of scale atop a thin pink plaque.
Copyright © 2021 VisualDx®. All rights reserved.