Actinic keratosis

• Actinic keratosis aka solar keratosis:

  • A precancerous scaly spot found on sun-damaged skin
  • An early form of cutaneous squamous cell carcinoma
• Risk factors:

  • Significant sun exposure with predisposing factors:
  • Fair skin
  • History of sunburn
  • Immunosuppression - unable to get rid of damaged/mutated cells - multiple immunosuppressive drugs are known to cause skin cancer e.g. TNF inhibitor infliximab
• Clinical features:

  • May be solitary but often multiple keratoses seen
  • Flat or thickened papule or plaque
  • White or yellow scaly warty or horny surface - feels rough
  • Skin coloured, red or pigmented
  • Usually do not exceed 1cm in diameter
  • Can be tender or asymptomatic
  • Common sites - back of hands, face, ears, nose, cheeks, lips, temples, forehead, balding scalps
• Why should you identify and treat these?

  •Main concern is risk of developing cutaneous squamous cell carcinoma (SCC)

  •Someone who has >10 actinic keratosis has a 10-15% risk of developing SCC at some point

  •If an actinic keratosis becomes tender, thickened, ulcerated or starts enlarging this is suspicious of evolution to SCC
• How are these diagnosed?

  •Clinically – refer for below if unsure

  •Usually dermoscopy is sufficient

  •Occasionally biopsy required
• Red flags for SCC - 2WW:

  • Rapidly growing
  • Has a firm and fleshy base
  • Painful
  • Not responding to treatment
  • Having a thick scale
  • Ulcerated
• Management:

  • Usually removed due to risk of cancer
  • Cryotherapy using liquid nitrogen - usually first line but depends on availability in GP
  • Shave, curettage (scrape with sharp instrument) and electrocautery
  • Excision
  • Creams
  • Photodynamic therapy