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Spreading pigmented actinic keratosis: a review
Elizabeth E Uhlenhake1, Omar P Sangueza, Andrew D Lee
1Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1071, USA. euhlenha@neoucom.edu
Journal of the American Academy of Dermatology
|March 26, 2010
Summary
Spreading pigmented actinic keratosis (SPAK) is a common skin lesion that can mimic other conditions. Increased awareness and diagnostic guidelines are needed due to its potential association with melanoma in situ.
Area of Science:
- Dermatology
- Oncology
- Pathology
Background:
- Spreading pigmented actinic keratosis (SPAK) is an underrecognized variant of actinic keratosis (AK).
- SPAK can clinically resemble benign pigmented lesions and malignant melanomas, complicating diagnosis.
- This variant is often overlooked despite its prevalence.
Purpose of the Study:
- To review existing literature on SPAK.
- To identify research gaps for establishing diagnostic criteria.
- To enhance clinical awareness of SPAK.
Main Methods:
- Comprehensive literature search of PubMed and MEDLINE databases.
- Keywords included "spreading pigmented actinic keratosis" and related terms.
- Retrieved articles were reviewed and summarized.
Main Results:
- SPAK is a rare but challenging diagnosis, often confused with seborrheic keratosis, melanoma in situ, and lentigo maligna melanoma.
- Lesions are typically >1.5 cm, located on sun-exposed skin, and spread laterally.
- Histopathology shows AK features with increased basal melanization; malignancy potential is unknown.
- Destructive therapies like cryotherapy are suggested.
Conclusions:
- SPAK diagnosis warrants suspicion for coexisting melanoma in situ.
- Further research is needed to fully elucidate SPAK's characteristics and malignancy potential.
- Unpublished data may exist, limiting comprehensive analysis.
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