What are the characteristics of actinic keratosis (AK), and how may its malignant potential be assessed?

Updated: Jan 30, 2020
  • Author: Ginard I Henry, MD; Chief Editor: Gregory Gary Caputy, MD, PhD, FICS  more...
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Actinic keratoses may demonstrate certain excrescences of keratin, referred to as cutaneous horns. The rough texture of the lesion imparts to the skin a sandpaper-like consistency. The color may be red, yellow, brown, or gray. Actinic keratoses may bear a clinical resemblance to psoriasis, Bowen disease, or Paget disease. The most important attribute is its premalignant potential. The annual incidence of malignant transformation from actinic keratosis to squamous cell carcinoma is likely less than 1% per year per individual lesion.

A study by Tokez et al identified predictor variables that can be used to assess the risk of that patients with actinic keratosis will develop a first keratinocyte carcinoma. The factors included the existence of 4-9 actinic keratoses (hazard ratio [HR]: 1.68), the presence of 10 or more of these lesions (HR: 2.43), localization of actinic keratosis on the upper extremities (HR: 0.75), localization elsewhere on the body except the head (HR: 1.40), and coffee consumption (HR: 0.92). [19]

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