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Solar Keratosis (Actinic Keratosis)

Solar Keratosis (Actinic keratosis) is a common premalignant skin lesion seen on areas of the body that have been exposed to sun. Premalignant means that the lesions have the potential to become skin cancer.

The Solar Keratosis is the earliest identifiable lesion that can eventually develop into an invasive squamous cell carcinoma (SCC). These Solar Keratosis lesions are diagnosed in 14 percent of all visits to dermatologists, following only acne and dermatitis in frequency. Debate swirls around the nomenclature for these Solar Keratosis lesions because some consider them to be pre-cancerous and others consider Solar Keratosis to be a SCC confined to the lower portion of the epidermis. Solar Keratosis typically occur in fair-skinned individuals. In various northern hemisphere populations, 11 percent to 25 percent of adults have at least one Solar Keratosis lesion, compared to 40 percent to 60 percent of adult Australians who live closer to the equator. One prospective study estimates that one Solar Keratosis/1,000/year transforms into SCC, whereas retrospective studies predict that from 5 percent to 20 percent of all untreated Solar Keratosis (Actinic keratosis) lesions will progress to SCC. Solar Keratosis are typically produced by ultraviolet radiation, but ionizing radiation, arsenic, or polycyclic hydrocarbon exposure might also cause them. At least two prospective studies have demonstrated that sunscreen reduces the likelihood of developing more Solar Keratosis.

On physical examination, the typical Solar Keratosis is a poorly demarcated, slightly erythematous papule or plaque found on sun-exposed areas such as the face, balding scalp, posterior neck, and dorsal upper extremity. Characteristically, Solar Keratosis (Actinic keratosis)feel rough or gritty and might be difficult to see. Therefore, palpation of high-risk areas under an intense light source is essential to accurate diagnosis. Microscopically, one sees large keratinocytes with atypical nuclei in the lower portion of the epidermis. Liquid nitrogen, 5-fluorouracil cream, trichloroacetic acid, electrodesiccation and curettage, and CO2 laser all can eradicate Solar Keratosis(Actinic keratosis). Two newer treatment modalities include photodynamic therapy and the topical immunomodulator, imiquimod.

A single Solar Keratosis may appear at first, but most people with one Solar Keratosis will develop other Solar Keratosis lesions. Solar Keratosis (Actinic keratosis) can appear in groups and may occasionally itch or become tender, especially after sun exposure.


2008 Solar Keratosis