- A diagnosis of actinic keratoses (AK) is rendered
Further to the case in question, general evaluation strategy for
AK is provided below.
Assess patient's history for factors that increase risk of
developing AK and/or non-melanoma skin cancer:
- Cumulative ultraviolet radiation (sunlight, artificial light)
- Arsenic exposure
- History of immunocompromised status (HIV/ AIDS, solid organ or
bone marrow transplant, immunosuppressive therapy)
- Genodermatoses involving photosensitivity and accelerated
photo-aging and/or cutaneous neoplasms (xeroderma pigmentosum,
albinism, Rothmund-Thomson syndrome)
Numerous AKs on sun-damaged skin are characterized by
ill-defined hyperkeratotic erythematous papules or plaques. AKs are
commonly very thin and may lack erythema, and are best discerned
clinically by palpation rather than visual inspection.
AKs can present with a cutaneous horn, a column of
hyperkeratotic scale lying over an ill-defined erythematous scaly
- Liquid nitrogen spray (thaw time 8 seconds)
- Liquid nitrogen can be applied by:
- Application by cryo spray; use of a specialized plastic cone or
otoscope piece may aid in focusing the spray at the base of the
- Application of cotton swab dipped in liquid nitrogen to
- Application of metal forceps dipped in liquid nitrogen to base
- Counseling of sequelae and skin care after treatment
- Follow-up in 6-8 weeks
Follow-up evaluation strategy
At 8 weeks:
- Lesion has been completely eradicated, with only faint macular
erythema; here, no induration or scale present
- Photoprotection counseling
- Follow-up for skin exam in 6 months
AKs typically present as scaly, erythematous papules or plaques
on sun-exposed areas, and are the most common epithelial
precancerous skin lesions. Clinical variants of AKs include:
erythematous, atrophic, hyperkeratotic, pigmented and lichenoid
forms. AKs on the lower lip are termed actinic cheilitis. Treatment
is necessary because approximately 5-15% of lesions may progress to
non-melanoma skin cancer (NMSC).
Three strategies for treatment are most frequently used:
- Physical destruction
- Topical chemotherapy
- Local stimulation of the immune system
Therapy is determined by location (face, scalp, forearms or
legs), extent and number (few versus multiple) of the lesions.
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Guidelines on the use of photodynamic therapy for nonmelanoma skin
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