Difference between revisions of "Actinic keratosis"

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Actinic keratosis (view source)

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→‎Histologic subtypes of actinic keratosis
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#redirect [[Non-malignant_skin_disease#Actinic_keratosis]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Actinic Keratosis, H&E.jpg
| Width      = Actinic keratosis. [[H&E stain]].
| Caption    =
| Micro      = basal epidermal atypia - key feature, palisading of basal cells, [[solar elastosis]] +/-parakeratosis
| Subtypes  = bowenoid actinic keratosis, hypertrophic actinic keratosis, acantholytic actinic keratosis, proliferative actinic keratosis, pigmented actinic keratosis, lichenoid actinic keratosis
| LMDDx      = [[squamous cell carcinoma of the skin]], [[Bowen's disease]]
| Stains    =
| IHC        = CK34betaE12 +ve
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[skin]]
| Assdx      = [[squamous cell carcinoma of the skin]], [[Bowen's disease]]
| Syndromes  =
| Clinicalhx =
| Signs      = sandpaper-like texture
| Symptoms  =
| Prevalence =
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = good
| Other      =
| ClinDDx    = [[squamous cell carcinoma of the skin|squamous cell carcinoma]], [[melanoma]] (for pigmented AK)
}}
'''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.
*Usually small (<1cm), but larger lesions may occur.
*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>
**One should see benign melanocytes within an AK... otherwise one should do stains as the melanocytes may be mimicking keratinocytes.
*[[Seborrheic keratosis]] - should not have basilar nuclear atypia.
*[[Lichenoid keratosis]] (esp. for ''lichenoid actinic keratosis'') - has a band of inflammatory cells in the superficial dermis.
*Discoid Luphus Erythematosus.
 
===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:SkinTumors-P5280056.JPG | Actinic keratosis. (WC)
</gallery>
<gallery>
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 - band of inflammatory cells at the dermal-epidermal junction.
**DDx: [[lichen planus]].
*Atrophic 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.
 
=====Lichenoid AK=====
The sections show skin with a lymphoplasmacytic interface dermatitis, hypergranulosis, hyperkeratosis, loss of the rete ridges and apoptotic keratinocytes. The epidermis matures to the surface; however, there is basal cell hyperplasia associated with moderate keratinocyte nuclear atypia (including hyperchromasia and anisonucleosis). Pigment incontinence is present. Solar elastosis is present.  The lesion is completely excised in the plane of section.
 
==See also==
*[[Non-malignant skin disease]].
*[[Dermatopathology]].
*[[Squamous cell carcinoma of the skin]].
 
==References==
{{Reflist|2}}
 
[[Category:Diagnosis]]
Abraham
98

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