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Review
. Nov-Dec 2019;94(6):637-657.
doi: 10.1016/j.abd.2019.10.004. Epub 2019 Nov 6.

Actinic Keratoses: Review of Clinical, Dermoscopic, and Therapeutic Aspects

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Free PMC article
Review

Actinic Keratoses: Review of Clinical, Dermoscopic, and Therapeutic Aspects

Clarissa Prieto Herman Reinehr et al. An Bras Dermatol. .
Free PMC article

Abstract

Actinic keratoses are dysplastic proliferations of keratinocytes with potential for malignant transformation. Clinically, actinic keratoses present as macules, papules, or hyperkeratotic plaques with an erythematous background that occur on photoexposed areas. At initial stages, they may be better identified by palpation rather than by visual inspection. They may also be pigmented and show variable degrees of infiltration; when multiple they then constitute the so-called field cancerization. Their prevalence ranges from 11% to 60% in Caucasian individuals above 40 years. Ultraviolet radiation is the main factor involved in pathogenesis, but individual factors also play a role in the predisposing to lesions appearance. Diagnosis of lesions is based on clinical and dermoscopic examination, but in some situations histopathological analysis may be necessary. The risk of transformation into squamous cell carcinoma is the major concern regarding actinic keratoses. Therapeutic modalities for actinic keratoses include topical medications, and ablative and surgical methods; the best treatment option should always be individualized according to the patient.

Keywords: Dermoscopy; Keratosis, actinic; Neoplasms, squamous cell; Precancerous conditions; Skin neoplasms.

Figures

Figure 1
Figure 1
Mechanisms involved in actinic keratoses pathogenesis. Adapted from: Berman B, Cockerell CJ. Pathobiology of actinic keratosis: ultraviolet-dependent keratinocyte proliferation. Berman B, et al. (2013).
Figure 2
Figure 2
Non-pigmented facial actinic keratoses: multiple small papules and erythematous plaques with whitish scales on the surface and varying degrees of hyperkeratosis.
Figure 3
Figure 3
Dermoscopic image (FotoFinder®, x20) of the “strawberry” pattern observed in facial actinic keratosis.
Figure 4
Figure 4
Dermoscopy of facial pigmented actinic keratosis (FotoFinder®, x20): a brownish pseudonetwork that spares follicular ostia is observed, in addition to surface scales and underlying vascular pseudonetwork.
Figure 5
Figure 5
Dermoscopy of extra-facial pigmented actinic keratosis located on the forearm: homogenous brownish pigment with whitish scales on the lesion surface can be observed (FotoFinder®, x20).

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