Difference between revisions of "Actinic keratosis"
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# | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | |||
| Image = | |||
| Width = | |||
| Caption = | |||
| Micro = basal epidermal atypia - key feature, palisading of basal cells, +/-parakeratosis | |||
| Subtypes = bowenoid actinic keratosis, hypertrophic actinic keratosis, acantholytic actinic keratosis, proliferative actinic keratosis, pigmented actinic keratosis, lichenoid actinic keratosis | |||
| LMDDx = | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[skin]] | |||
| Assdx = [[squamous cell carcinoma of the skin]], [[Bowen's disease]] | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = good | |||
| Other = | |||
| ClinDDx = [[squamous cell carcinoma of the skin|squamous cell carcinoma]] | |||
}} | |||
'''Actinic_keratosis''', abbreviated '''AK''', is a common [[skin]] lesion. It is also known as '''solar keratosis'''.<ref name=pmid18393780>{{Cite journal | last1 = Weinberg | first1 = JM. | title = Topical therapy for actinic keratoses: current and evolving therapies. | journal = Rev Recent Clin Trials | volume = 1 | issue = 1 | pages = 53-60 | month = Jan | year = 2006 | doi = | PMID = 18393780 }}</ref><ref name=pmid18067626>{{Cite journal | last1 = Roewert-Huber | first1 = J. | last2 = Stockfleth | first2 = E. | last3 = Kerl | first3 = H. | title = Pathology and pathobiology of actinic (solar) keratosis - an update. | journal = Br J Dermatol | volume = 157 Suppl 2 | issue = | pages = 18-20 | month = Dec | year = 2007 | doi = 10.1111/j.1365-2133.2007.08267.x | PMID = 18067626 }}</ref> | |||
==General== | |||
*Considered a precursor of [[squamous cell carcinoma of the skin]].<ref name=pmid18067626>{{Cite journal | last1 = Roewert-Huber | first1 = J. | last2 = Stockfleth | first2 = E. | last3 = Kerl | first3 = H. | title = Pathology and pathobiology of actinic (solar) keratosis - an update. | journal = Br J Dermatol | volume = 157 Suppl 2 | issue = | pages = 18-20 | month = Dec | year = 2007 | doi = 10.1111/j.1365-2133.2007.08267.x | PMID = 18067626 }}</ref> | |||
Risk factors:<ref name=Ref_PBoD8_1180>{{Ref PBoD8|1180}}</ref> | |||
*Sun exposure. | |||
*Immune suppression (e.g. organ transplant recipients). | |||
==Gross== | |||
Features: | |||
*Yellow-brown scaly, patches. | |||
*Sandpaper sensation - on touching. | |||
*May be pigmented.<ref>URL: [http://www.dermoscopy-ids.org/index.php/newest-case/79-lentigo-maligna-vs-pigmented-actinic-keratosis http://www.dermoscopy-ids.org/index.php/newest-case/79-lentigo-maligna-vs-pigmented-actinic-keratosis]. Accessed on: 23 August 2012.</ref> | |||
==Microscopic== | |||
Features:<ref>URL: [http://emedicine.medscape.com/article/1099775-workup#a0723 http://emedicine.medscape.com/article/1099775-workup#a0723]. Accessed on: 1 September 2011.</ref> | |||
*Epidermal nuclear atypia: | |||
**Variation is size, shape and staining - must involve basilar layer. | |||
***Nuclear enlargement - '''key feature'''. | |||
***Hyperchromasia. | |||
*Abnormal epidermal architecture: | |||
**Palisading.{{Fact}} | |||
*+/-Parakeratosis - may alternate with orthokeratosis, esp. early lesions.<ref name=Ref_Derm353>{{Ref Derm|353}}</ref> | |||
*+/-Irregular acanthosis. | |||
Note: | |||
*May be full thickness - known as ''bowenoid actinic keratosis''.<ref name=pmid19515076>{{Cite journal | last1 = Bagazgoitia | first1 = L. | last2 = Cuevas | first2 = J. | last3 = Juarranz | first3 = A. | title = Expression of p53 and p16 in actinic keratosis, bowenoid actinic keratosis and Bowen's disease. | journal = J Eur Acad Dermatol Venereol | volume = 24 | issue = 2 | pages = 228-30 | month = Feb | year = 2010 | doi = 10.1111/j.1468-3083.2009.03337.x | PMID = 19515076 }}</ref> | |||
DDx: | |||
*[[Actinic cheilitis]] - the same lesion on the lip.<ref name=pmid3305604>{{Cite journal | last1 = Picascia | first1 = DD. | last2 = Robinson | first2 = JK. | title = Actinic cheilitis: a review of the etiology, differential diagnosis, and treatment. | journal = J Am Acad Dermatol | volume = 17 | issue = 2 Pt 1 | pages = 255-64 | month = Aug | year = 1987 | doi = | PMID = 3305604 }}</ref> | |||
*[[Bowen's disease]] - full thickness involvement - with involvement of adnexal epithelium and follicular epithelium.<ref name=pmid19515076/> | |||
*[[Paget disease of the breast]]. | |||
*[[Squamous cell carcinoma of the skin]]. | |||
*[[Lentigo maligna]] (melanoma in situ on sun damaged skin) - esp. for ''pigmented AK''.<ref name=Ref_Derm353>{{Ref Derm|353}}</ref> | |||
*[[Seborrheic keratosis]] - should not have basilar nuclear atypia. | |||
===Images=== | |||
<gallery> | |||
Image:Actinic_Keratosis,_H%26E.jpg | Actinic keratosis. (WC) | |||
Image:SkinTumors-P5280065.JPG | Actinic keratosis. (WC) | |||
Image:SkinTumors-P5280055.JPG | Actinic keartosis. (WC) | |||
Image:Bowenoid_actinic_keratosis_-_high_mag.jpg | Bowenoid actinic keratosis - high mag. (WC) | |||
Image:Bowenoid_actinic_keratosis_-_very_high_mag.jpg | Bowenoid actinic keratosis - very high mag. (WC) | |||
</gallery> | |||
===Histologic subtypes of actinic keratosis=== | |||
Like most common things, there are several variants:<ref name=Ref_Derm353>{{Ref Derm|353}}</ref> | |||
*Hypertrophic actinic keratosis. | |||
**Increased thickness of: (1) epidermis and, (2) stratum corneum.<ref name=Ref_Derm352>{{Ref Derm|352}}</ref> | |||
*Acantholytic actinic keratosis. | |||
*Proliferative actinic keratosis - downward finger-like projections of the epidermis. | |||
*Pigmented actinic keratosis. | |||
**DDx: [[lentigo maligna]]. | |||
*Lichenoid actinic keratosis. | |||
==Sign out== | |||
<pre> | |||
SKIN LESION, RIGHT THIGH, BIOPSY: | |||
- HYPERTROPHIC ACTINIC KERATOSIS. | |||
- SOLAR ELASTOSIS. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
===Bowenoid=== | |||
<pre> | |||
SKIN LESION, RIGHT DISTAL FOREARM, BIOPSY: | |||
- BOWENOID ACTINIC KERATOSIS, COMPLETELY EXCISED IN PLANE OF SECTION. | |||
- EXTENSIVE SOLAR ELASTOSIS. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
====Micro==== | |||
=====General===== | |||
The sections show skin with basilar epidermal nuclear enlargement and hyperchromasia with irregular nuclear palisading. Hyperkeratosis and parakeratosis is present. A granular layer is present. The dermal-epidermal interface is sharply-demarcated. There is focal inflammation at the interface. Extensive solar elastosis is present. | |||
There is no clefting of the lesion from the surrounding stroma. The surrounding stroma does not have a myxoid quality. | |||
=====Bowenoid===== | |||
The sections show skin with epidermal nuclear enlargement and hyperchromasia with irregular nuclear palisading. The lesion involves the full thickness of the epidermis; however, it spares adnexal and follicular epithelium. Proliferative activity is present. Hyperkeratosis and parakeratosis is present. A granular layer is present. The dermal-epidermal interface is sharply-demarcated. There is focal inflammation at the interface. Extensive solar elastosis is present. | |||
There is no clefting of the lesion from the surrounding stroma. Intercellular bridges are identified. | |||
==See also== | |||
*[[Non-malignant skin disease]]. | |||
*[[Dermatopathology]]. | |||
*[[Squamous cell carcinoma of the skin]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
Revision as of 23:41, 9 July 2013
| Actinic keratosis | |
|---|---|
| Diagnosis in short | |
|
| |
| LM | basal epidermal atypia - key feature, palisading of basal cells, +/-parakeratosis |
| Subtypes | bowenoid actinic keratosis, hypertrophic actinic keratosis, acantholytic actinic keratosis, proliferative actinic keratosis, pigmented actinic keratosis, lichenoid actinic keratosis |
| Site | skin |
|
| |
| Associated Dx | squamous cell carcinoma of the skin, Bowen's disease |
| Prognosis | good |
| Clin. DDx | squamous cell carcinoma |
Actinic_keratosis, abbreviated AK, is a common skin lesion. It is also known as solar keratosis.[1][2]
General
- Considered a precursor of squamous cell carcinoma of the skin.[2]
Risk factors:[3]
- Sun exposure.
- Immune suppression (e.g. organ transplant recipients).
Gross
Features:
- Yellow-brown scaly, patches.
- Sandpaper sensation - on touching.
- May be pigmented.[4]
Microscopic
Features:[5]
- Epidermal nuclear atypia:
- Variation is size, shape and staining - must involve basilar layer.
- Nuclear enlargement - key feature.
- Hyperchromasia.
- Variation is size, shape and staining - must involve basilar layer.
- Abnormal epidermal architecture:
- Palisading.[citation needed]
- +/-Parakeratosis - may alternate with orthokeratosis, esp. early lesions.[6]
- +/-Irregular acanthosis.
Note:
- May be full thickness - known as bowenoid actinic keratosis.[7]
DDx:
- Actinic cheilitis - the same lesion on the lip.[8]
- Bowen's disease - full thickness involvement - with involvement of adnexal epithelium and follicular epithelium.[7]
- Paget disease of the breast.
- Squamous cell carcinoma of the skin.
- Lentigo maligna (melanoma in situ on sun damaged skin) - esp. for pigmented AK.[6]
- Seborrheic keratosis - should not have basilar nuclear atypia.
Images
Actinic keratosis. (WC)
Actinic keratosis. (WC)
Actinic keartosis. (WC)
Bowenoid actinic keratosis - high mag. (WC)
Bowenoid actinic keratosis - very high mag. (WC)
Histologic subtypes of actinic keratosis
Like most common things, there are several variants:[6]
- Hypertrophic actinic keratosis.
- Increased thickness of: (1) epidermis and, (2) stratum corneum.[9]
- Acantholytic actinic keratosis.
- Proliferative actinic keratosis - downward finger-like projections of the epidermis.
- Pigmented actinic keratosis.
- DDx: lentigo maligna.
- Lichenoid actinic keratosis.
Sign out
SKIN LESION, RIGHT THIGH, BIOPSY: - HYPERTROPHIC ACTINIC KERATOSIS. - SOLAR ELASTOSIS. - NEGATIVE FOR MALIGNANCY.
Bowenoid
SKIN LESION, RIGHT DISTAL FOREARM, BIOPSY: - BOWENOID ACTINIC KERATOSIS, COMPLETELY EXCISED IN PLANE OF SECTION. - EXTENSIVE SOLAR ELASTOSIS. - NEGATIVE FOR MALIGNANCY.
Micro
General
The sections show skin with basilar epidermal nuclear enlargement and hyperchromasia with irregular nuclear palisading. Hyperkeratosis and parakeratosis is present. A granular layer is present. The dermal-epidermal interface is sharply-demarcated. There is focal inflammation at the interface. Extensive solar elastosis is present.
There is no clefting of the lesion from the surrounding stroma. The surrounding stroma does not have a myxoid quality.
Bowenoid
The sections show skin with epidermal nuclear enlargement and hyperchromasia with irregular nuclear palisading. The lesion involves the full thickness of the epidermis; however, it spares adnexal and follicular epithelium. Proliferative activity is present. Hyperkeratosis and parakeratosis is present. A granular layer is present. The dermal-epidermal interface is sharply-demarcated. There is focal inflammation at the interface. Extensive solar elastosis is present.
There is no clefting of the lesion from the surrounding stroma. Intercellular bridges are identified.
See also
References
- ↑ Weinberg, JM. (Jan 2006). "Topical therapy for actinic keratoses: current and evolving therapies.". Rev Recent Clin Trials 1 (1): 53-60. PMID 18393780.
- ↑ 2.0 2.1 Roewert-Huber, J.; Stockfleth, E.; Kerl, H. (Dec 2007). "Pathology and pathobiology of actinic (solar) keratosis - an update.". Br J Dermatol 157 Suppl 2: 18-20. doi:10.1111/j.1365-2133.2007.08267.x. PMID 18067626.
- ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1180. ISBN 978-1416031215.
- ↑ URL: http://www.dermoscopy-ids.org/index.php/newest-case/79-lentigo-maligna-vs-pigmented-actinic-keratosis. Accessed on: 23 August 2012.
- ↑ URL: http://emedicine.medscape.com/article/1099775-workup#a0723. Accessed on: 1 September 2011.
- ↑ 6.0 6.1 6.2 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 353. ISBN 978-0443066542.
- ↑ 7.0 7.1 Bagazgoitia, L.; Cuevas, J.; Juarranz, A. (Feb 2010). "Expression of p53 and p16 in actinic keratosis, bowenoid actinic keratosis and Bowen's disease.". J Eur Acad Dermatol Venereol 24 (2): 228-30. doi:10.1111/j.1468-3083.2009.03337.x. PMID 19515076.
- ↑ Picascia, DD.; Robinson, JK. (Aug 1987). "Actinic cheilitis: a review of the etiology, differential diagnosis, and treatment.". J Am Acad Dermatol 17 (2 Pt 1): 255-64. PMID 3305604.
- ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 352. ISBN 978-0443066542.