Difference between revisions of "Actinic keratosis"

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Actinic keratosis (view source)

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#redirect [[Non-malignant_skin_disease#Actinic_keratosis]]
{{ 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]]
Michael
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