Actinic Keratosis (AK)
Actinic Keratosis (sometimes called Solar Keratosis) presents
as red, scaly or hyperkeratotic lesions that feel like rough sand
paper, compared to the unaffected surrounding skin. AKs are
commonly found on sun-exposed areas such as the head, neck,
forearms and hands. 6 Lesions are usually flat and take on a
similar appearance rarely exceeding 1 cm in diameter. The skin
often presents with other sun damage symptoms including
pigment irregularity, telangiectasia and erythema (redness).
Individuals with fair skin, blue eyes and blonde hair are at
higher risk, whereas lesions are (exceedingly) rare in patients of
Asian and African origin. 7 Artificial UV radiation used to treat
other skin conditions, as well as the use of sun beds can also
increase the risk of developing AK.
AKs are considered to be pre-cancerous and can be a precursor
to Squamous Cell Carcinoma (SCC). 8 The National Institute of
Clinical Evidence (NICE) estimates that over 23% of the UK
population aged 60 and above have AKs. 9 The risk of a single
AK transforming into a squamous cell carcinoma (SCC) is very
low, the risk increases over time and with larger numbers of
lesions. The presence of ten AKs is associated with a 14% risk of
developing an SCC within five years. 10 Cutaneous horn can also
develop at the site of AK. 11
Management
Given the very large numbers of patients who have AKs,
the majority are managed in the community, by their GP. Not
all patients need treatment. But it is important to remember
that AK is a marker of sun damage. Patients with a significant
number of AKs should be referred to their GP for a thorough
skin examination to look for more serious sun-related skin
tumours. If SCC is suspected, referral to Secondary Care as a
2-week-wait-rule should be initiated.
Single lesions can be treated with topical treatments or
cryotherapy. Areas of field damage are usually treated more
vigorously with topical treatments or with photodynamic
therapy. Excision of the affected area or removal of the AK by
curettage are also used as treatment. 12
Figure 5 AK is the result of cumulative long-term
sun-exposure, this 83 year old gentleman spent a lot of
time outdoors and abroad, with little UV protection
See more images of Actinic Keratosis on
CETpoints.com
Seborrhoeic Keratosis
Seborrhoeic keratosis is also known as SK, basal cell papilloma,
senile wart or brown wart. SKs are warty, waxy-looking lesions
with a stuck-on appearance. They are very common, harmless,
often pigmented (from very light to very dark brown), growths
on the skin. Seborrhoeic keratoses can arise on any area of skin,
with the exception of palms and soles, and do not affect mucous
membranes such as the conjunctiva. 13 SKs occur most often on the
trunk, but they are also common on the head and neck. They are
not thought to be associated with UV exposure.
Generally they are raised above the skin surface, although some
can be quite flat, making it hard to distinguish them from lentigo
or even a superficial melanoma. They are rare in patients under
20 but very common in elderly people. It has been estimated that
over 90% of adults over the age of 60 years have one or more of
them. 14 Some people will only have a few seborrhoeic keratoses,
while others may have hundreds. They are not infectious and
do not become malignant. 15 They can itch, become inflamed,
and catch on clothing. Many people dislike the look of them,
particularly when they occur on the face.
Management
Most SKs need no treatment, they are harmless and cause no
symptoms. Patients with large or troublesome SKs should be
referred to their GP or an Aesthetic clinic to discuss treatment
options. Treatment is usually by cryotherapy or curettage under
14 etCETera | April 2017
Figure 6 The term ‘field change’ is used when large areas
are affected. Men tend to be more affected than women