Actinic keratosis: rationale and management

Area of Science:

• Dermatology
• Oncology
• Skin Cancer Research

Background:

• Actinic keratoses (AKs) are common skin lesions associated with ultraviolet (UV) radiation exposure.
• AKs represent an increased risk for developing squamous cell carcinoma (SCC) and other skin malignancies.
• The immunosuppressed population and fair-skinned individuals are particularly susceptible to AK development.

Purpose of the Study:

• To review the pathophysiology and epidemiology of AKs.
• To describe the rationale behind current AK management strategies.
• To highlight the most up-to-date understanding of AK disease and its treatment.

Main Methods:

• Literature review of PubMed and MEDLINE databases.
• Search conducted for articles published between January 1, 2000, and September 18, 2013.
• Inclusion of relevant articles published prior to the specified date range.

Main Results:

• AK formation involves inflammation, oxidative stress, immunosuppression, impaired apoptosis, mutagenesis, and dysregulated cell growth.
• Field cancerization principle guides management, addressing both individual lesions and surrounding affected skin.
• Current therapies include lesion-directed (cryotherapy, excision) and field-directed (topical 5-fluorouracil, imiquimod, diclofenac, photodynamic therapy, ingenol mebutate) treatments.

Conclusions:

• Understanding AK mechanisms supports current therapeutic approaches.
• Combined lesion- and field-directed therapies show promising results.
• Treatment is individualized, making a universal gold standard algorithm challenging; novel therapies are being investigated.