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Actinic keratosis

Last reviewed: 10 Nov 2024
Last updated: 04 Nov 2022

Summary

Definition

History and exam

Key diagnostic factors

  • single or multiple scaly macules or plaques
  • scaly lesions with a hyperkeratotic surface
  • well-defined, scaly, brown lesions
  • lesions resembling seborrheic keratosis, melanocytic nevus, and early malignant melanoma
  • hypertrophic conical-shaped protuberances growing from the surface of the skin
  • scaly red roughness with induration, fissuring, and ulceration of the lower lip to the commissures
  • lesion on sun-exposed area of body
  • skin-colored, papillomatous, elevated wartlike papules
  • plaques with very mild scale over very thin shiny skin
  • violaceous well-defined papules with fine white lines on the surface
Full details

Other diagnostic factors

  • evidence of sun damage to skin
  • pruritus or bleeding
Full details

Risk factors

  • chronic exposure to UVB radiation
  • light-colored skin, freckling, and albinism
  • age >40 years
  • male sex
  • immunocompromise
  • xeroderma pigmentosum
Full details

Diagnostic tests

Tests to consider

  • dermoscopy
  • skin biopsy
Full details

Treatment algorithm

ONGOING

confluent scalp lesions

head and face lesions, excluding periorbital, actinic cheilitis, and confluent scalp lesions

periorbital

persistent or severe actinic cheilitis

back of hands

below the knee

Contributors

Authors

Brian Berman, MD, PhD
Brian Berman

Professor Emeritus of Dermatology and Cutaneous Surgery

University of Miami Miller School of Medicine

Miami

Skin & Cancer Associates, LLP

Co-Director

Center for Clinical and Cosmetic Research

Aventura

FL

Disclosures

BB is, or has been, a paid consultant/advisor for Almirall (manufacturer of tirbanibulin), TopMD, Lemonex, Berg Pharma, Novartis, Aiviva, Ferndale, Sensus, Novan, Klara, Pierre Fabre (manufacturer of 5-FU), Biofrontera (manufacturer of ALA), SUN (manufacturer of ALA), LEO (manufacturer of ingenol mebutate), Pulse, Sirnaomics, Menlo, Sonoma, PHD Biosciences, Birch BioMed, Mediwound, Mino Labs. He has been a speaker for Almirall (manufacturer of tirbanibulin), LEO (manufacturer of ingenol mebutate), Sensus. His institution has received investigator funding from Biofrontera (manufacturer of ALA), LEO (manufacturer of ingenol mebutate), Pulse, Sirnaomics, Menlo, Birch BioMed, Mediwound.

Sadegh Amini, MD
Sadegh Amini

Dermatologist

Skin and Cancer Associates

Voluntary Assistant Professor

Department of Dermatology and Cutaneous Surgery

University of Miami

Miller School of Medicine

Miami

FL

Disclosures

SA declares that he owns stock in AbbVie Inc.

Peer reviewers

David S. Cassarino, MD, PhD

Assistant Professor

Departments of Pathology and Dermatology

UCLA

Los Angeles

CA

Disclosures

DSC declares that he has no competing interests.

Christopher Shea, MD

Dermatopathology Fellowship Director

University of Chicago

Section of Dermatology

Chicago

IL

Disclosures

CS declares that he has no competing interests.

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    • Invasive SCC
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  • Guidelines

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    • Guidelines of care for the management of actinic keratosis
    More Guidelines
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