Actinic keratosis: the facts about biological behaviour and clinico-pathological aspects of the disease from the view of pathologist

Czech version

Authors: V. Bartoš ¹; K. Adamicová ²; M. Péč ³
Authors‘ workplace: Oddelenie patologickej anatómie FNsP, Žilina, Slovenská republika, Vedúci: prim. MUDr. Dušan Pokorný ¹; Ústav patologickej anatómie Jesseniovej lekárskej fakulty a UNM v Martine, Vedúci: prof. MUDr. Lukáš Plank, CSc. ²; Ústav lekárskej biológie Jesseniovej lekárskej fakulty v Martine, Vedúci: doc. MUDr. Martin Péč, PhD. ³
Published in: Prakt. Lék. 2011; 91(11): 646-652
Category: Various Specialization

Overview

Actinic keratosis (AK) is a very frequently diagnosed disorder in dermatological practice that mostly arises on the parts of the body that are exposed to the sun. This cutaneous lesion has been historically considered precancerosis, but currently it is recommended to classify it as squamous cell carcinoma (SCC) in situ. The course of the disease is usually heterogeneous. Individual lesions may

regress spontaneously,
recur,
persist without changes for a long time, or
can progress to invasive cancer.

It is known that AK and SCC of the skin represent a continuous evolutionary process that begins with ultraviolet radiation-induced damage of keratinocyte DNA, continues with clonal expansion of genetically altered cells, and ends with invasive carcinoma. The process of the malignant transformation of AK and cutaneous SCC development is similar to a mechanism of uterine cervix SCC development called cervical intraepithelial neoplasia. Therefore, an analogous classification scheme for the neoplastic changes of epidermis has been proposed named keratinocyte intraepidermal neoplasia.

This 3-tiered grading system better reflects the process of gradual malignant transformation of the epidermis, but controversy still persists about its practical application. Although the malignant potential of AK is relatively low, we do not know any reliable clinico-pathological factors to predict disease outcome. That is why there is still a need for new studies focusing on the pathogenesis and biological behaviour of AK. In clinical practice, this is illustrated by the dilemma of whether all lesions unconditionally require treatment, and which is the most appropriate therapy for individual lesions.

Key words:
actinic keratosis, keratinocyte intraepidermal neoplasia, squamous cell

Sources

1. Ackerman, A.B. Solar keratosis is squamous cell carcinoma. Arch. Dermatol. 2003, 139, p. 1216–1217.

2. Ashton, K.J., Weinstein, S.R., Maguire, D.J., Griffiths, L.R. Chromosomal aberrations in squamous cell carcinoma and solar keratoses revealed by comparative genomic hybridization. Arch. Dermatol. 2003, 139, p. 876-882.

3. Barzilai, A., Lyakhovitsky, A., Trau, H. et al. Expression of p53 in the evolution of squamous cell carcinoma: correlation with the histology of the lesion. J. Am. Acad. Dermatol. 2007, 57(4), p. 669-676.

4. Berhane, T., Halliday, G.M., Cooke, B., Barnetson, R.S. Inflammation is associated with progression of actinic keratoses to squamous cell carcinomas in humans. Br. J. Dermatol. 2002, 146, p. 810-815.

5. Berman, B., Bienstock, L., Kuritzky, L. et al. Actinic keratoses: sequelae and treatments. Recommendations from a consensus panel. J. Fam. Pract. 2006, 55(5), S1-S8.

6. Carag, H.R., Prieto, V.G., Yballe, L.S., Shea, C.R. Utility of step sections: Demonstration of additional pathological findings in biopsy samples initially diagnosed as actinic keratosis. Arch. Dermatol. 2000, 136, p. 471-475.

7. Cockerell, C.J. Histopathology of incipient intraepidermal squamous cell carcinoma (“actinic keratosis”). J. Am. Acad. Dermatol. 2000, 42(1 Pt 2), p. 11–17.

8. Cockerell, C.J., Wharton, J.R. New histopathological classification of actinic keratosis (incipient intraepidermal squamous cell carcinoma). J. Drugs. Dermatol. 2005, 4(4), p. 462-473.

9. Deltondo, J.A., Helm, K.F. Actinic keratosis: precancer, squamous cell carcinoma, or marker of field cancerization? G. Ital. Dermatol. Venereol. 2009, 144(4), p. 441-444.

10. Divišová, B., Cetkovská, P., Pizinger, K. Nejčastější maligní epitelové kožní nádory. Onkologie 2010, 4(4), s. 230-232.

11. Dodson, J.M., DeSpain, J., Hewett, J.E., Clark, D.P. Malignant potential of actinic keratoses and the controversy over treatment. A patient-oriented perspective. Arch. Dermatol. 1991, 127, p. 1029-1031.

12. Frost, C., Williams, G., Green, A. High incidence and regression rates of solar keratoses in a Queensland community. J. Invest. Dermatol. 2000, 115, p. 273-277.

13. Fu, W., Cockerell, C.J. The actinic (solar) keratosis: a 21st-century perspective. Arch. Dermatol. 2003, 139(1), p. 66–70.

14. Glogau, R.G. The risk of progression to invasive disease. J. Am. Acad. Dermatol. 2000, 42(1) Suppl 1, S23-S24.

15. Goldberg, L.H., Chang, J.R., Baer, S.C., Schmidt, J.D. Proliferative actinic keratosis: three representative cases. Dermatol. Surg. 2000, 26(1), p. 65-69.

16. Chang, S.N., Chun, S.I., Kim, S.N. et al. Clinical and histopathological observations of actinic keratoses in Korea. Korean J. Dermatol. 1997, 35(5), p. 931-939.

17. James, C., Crawford, R.I., Martinka, M., Marks, R. Actinic keratosis. In LeBoit P, Burg G, Weedon D, Sarasin A. World Health Organization Classification of Tumours, Pathology and Genetics of Skin tumours. Lyon: IARCPress, 2006; p. 30-33.

18. Litvik, R., Paciorek, M., Vantuchová, Y. Příspěvek k léčbě aktinických keratóz. Dermatol. praxi 2009, 3(4), s. 184-187.

19. Lober, B.A., Lober, C.W. Actinic keratosis is squamous cell carcinoma. Southern Med. J. 2000, 93, p. 650-657.

20. Lohmann, C.M., Solomon, A.R. Clinicopathologic variants of cutaneous squamous cell carcinoma. Adv. Anat. Pathol. 2001, 8(1), p. 27-36.

21. Marks, R., Foley, P., Goodman, G. et al. Spontaneous remission of solar keratoses: the case for conservative management. Br. J. Dermatol. 1986, 115, p. 649-655.

22. Marks, R., Rennie, G., Selwood, T.S. Malignant transformation of solar keratoses to squamous cell carcinoma. Lancet 1988, 1, p. 795-797.

23. Massa, A., Alves, R., Amado, J. et al. Prevalence of cutaneous lesions in Freixo de Espada a Cinta. Acta Med. Port. 2000, 13, p. 247-254.

24. Memon, A.A., Tomenson, J.A., Bothwell, J., Friedmann, P.S. Prevalence of solar damage and actinic keratosis in a Merseyside population. Br. J. Dermatol. 2000, 142, p. 1154-1159.

25. Mittelbronn, M.A., Mullins, D.L., Ramos-Caro, F.A., Flowers, F.P. Frequency of pre-existing actinic keratosis in cutaneous squamous cell carcinoma. Int. J. Dermatol. 1998, 37, p. 677-681.

26. Moy, R.L. Clinical presentation of actinic keratoses and squamous cell carcinoma. J. Am. Acad. Dermatol. 2000, 42, S8-S10.

27. Murad, A. Actinic keratoses: prevalence, pathogenesis, presentation, and prevention. Adv. Stud. Med. 2006, 6 (8A), S785-S790.

28. Naldi, L., Chatenoud, L., Piccitto, R. et al. Prevalence of actinic keratoses and associated factors in a representative sample of the Italian adult population: Results from the prevalence of actinic keratoses Italian study, 2003-2004. Arch. Dermatol. 2006, 142 (6), p. 722-726.

29. Padilla, R.S., Sebastian, S., Jiang, Z. et al. Gene expression patterns of normal human skin, actinic keratosis, and squamous cell carcinoma: a spectrum of disease progression. Arch. Dermatol. 2010, 146(3), p. 288-293.

30. Poláková, K. Nemelanómová rakovina kože – I. časť: Etiopatogenéza a klinický obraz. Dermatol. praxi 2008, 3, s. 112-115.

31. Poláková, K. Účinky topického imudomodulátoru (imiquimodu) v léčbe aktinické keratózy. Dermatol. praxi 2010, 4(2), s. 83-85.

32. Quaedvlieg, P.J., Tirsi, E., Thissen, M.R. et al. Actinic keratosis: how to differentiate the good from the bad ones ? Eu. J. Dermatol. 2006, 16(4), p. 335-339.

33. Ramzi, S.T., Maruno, M., Khaskhely, N.M. et al. An assessment of the malignant potential of actinic keratoses and Bowen’s disease; p53 and PCNA expression pattern correlate with the number of desmosomes. J. Dermatol. 2002, 29, p. 562-572.

34. Roewert-Huber, J. Actinic keratosis. In Stockfleth E (Eds). Managing skin cancer. Berlin, Heildelberg: Springer-Verlag, 2010, p. 20-21. ISBN 978-3-540-79346-5.

35. Rowert-Huber, J., Patel, M.J., Forschner, T. et al. Actinic keratosis is an early in situ squamous cell carcinoma: a proposal for reclassification. Br. J. Dermatol. 2007, 156 Suppl 3, p. 8-12.

36. Smoller, B.R. Squamous cell carcinoma: from precursor lesions to high-risk variants. Mod. Pathol. 2006, 19, (Suppl 2) S88-S92.

37. Stanimirovic, A., Cupic, H., Bosnjak, B. et al. Expression of p53, bcl-2 and growth hormone receptor in actinic keratosis, hypertrophic type. Arch. Dermatol. Res. 2003, 295, p. 102-108.

38. Thompson, S.C., Jolley, D., Marks, R. Reduction of solar keratoses by regular sunscreen use. N. Engl. J. Med. 1993, 329, p. 1147-1151.

39. Vatve, M., Ortonne, J.P., Birch-Machin, M.A., Gupta, G. Management of field change in actinic keratosis. Br. J. Dermatol. 2007, 157 (Suppl 2), p. 21-24.

40. Yantsos, V.A., Conrad, N., Zabawski, E., Cockerell, C.J. Incipient intraepiderrnal cutaneous squamous cell carcinoma: A proposal for reclassifying and grading solar (actinic) keratoses. Semin. Cutan. Med. Surg. 1999, 18, p. 3-14.

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Article was published in

General Practitioner

2011 Issue 11