Managing actinic keratosis in primary care

Area of Science:

• Dermatology
• Oncology

Background:

• Actinic keratosis (AK) arises from chronic ultraviolet (UV) radiation damage to the epidermis.
• Prevalence in the UK is 15-23%, with risk factors including age, male gender, sun exposure, and immunosuppression.
• AK is considered a premalignant lesion with a low risk (up to 0.5% per year) of transforming into invasive squamous cell carcinoma (SCC).

Purpose of the Study:

• To review the etiology, risk factors, clinical presentation, and management of actinic keratosis.
• To highlight the potential for malignant transformation and the importance of appropriate treatment.
• To emphasize diagnostic indicators and referral criteria for suspected cutaneous malignancy.

Main Methods:

• Literature review of actinic keratosis, focusing on epidemiology, risk factors, and clinical characteristics.
• Analysis of diagnostic signs, including dermatoscopy, and differentiation from other skin conditions.
• Evaluation of treatment indications and referral guidelines for secondary care.

Main Results:

• Actinic keratosis lesions present as hyperkeratotic papules, cutaneous horns, or flat lesions on sun-exposed skin.
• A sandpaper-like texture is a key diagnostic sign of actinic damage.
• While spontaneous regression occurs (20-30%), active treatment is advised due to the potential for SCC development.

Conclusions:

• Actinic keratosis requires active management due to its premalignant potential, especially in immunosuppressed individuals.
• Early recognition of clinical signs and consideration of SCC are crucial for patient management.
• Referral to secondary care is indicated for suspected cutaneous malignancy or severe, widespread actinic damage in immunosuppressed patients.