Clinicopathological analysis of actinic keratosis affecting the eyelid

Actinic Keratosis (AK) is a precancerous lesion related to radiation exposure, leading to malignant transformation (MT). This study aims to assess the epidemiological, clinical and histopathological features of AK in the eyelid to allow early diagnosis and treatment.

The McGill University Ocular Pathology & Translational Research Laboratory studied 200 biopsied lesions from 192 patients with a final diagnosis of AK amidst 1993 and 2023. Out of the total, 16 patients and 17 lesions were excluded due to insufficient data about the lesion's location. Samples from 176 patients (183 lesions) were analyzed.

The mean age of diagnosis for eyelid AK (EAK) was 73 years old. The co-occurrence of AK and squamous neoplasia within the same specimen was 18.6% for EAK. The typical histopathological variant was the more prevalent representing 53% of all EAK lesions. The most common lesion site in the eyelid was the lower eyelid, constituting for 52.2%.

To the best of our knowledge, this is the largest series of patients with EAK. This study emphasizes the importance of early excision with safety margins as a primary choice of treatment due to the risk of co-occurrence of AK and squamous neoplasia.