Clinical and Dermoscopic Diagnosis of Actinic Keratosis

Clinical and Dermoscopic Diagnosis of Actinic Keratosis

Authors

  • Claudio Conforti Istituto dermopatico dell’Immacolata, IDI-IRCCS, Dermatological Research Hospital, Rome, Italy.
  • Luca Ambrosio Istituto dermopatico dell’Immacolata, IDI-IRCCS, Dermatological Research Hospital, Rome, Italy
  • Chiara Retrosi Istituto dermopatico dell’Immacolata, IDI-IRCCS, Dermatological Research Hospital, Rome, Italy.
  • Carmen Cantisani Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
  • Giovanni Di Lella Istituto dermopatico dell’Immacolata, IDI-IRCCS, Dermatological Research Hospital, Rome, Italy.
  • Luca Fania Istituto dermopatico dell’Immacolata, IDI-IRCCS, Dermatological Research Hospital, Rome, Italy.
  • Roberta Rotunno Istituto dermopatico dell’Immacolata, IDI-IRCCS, Dermatological Research Hospital, Rome, Italy.
  • Iris Zalaudek Dermatology Clinic, Maggiore Hospital, Piazza Ospitale 1, Trieste, Italy
  • Giovanni Pellacani Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy

Keywords:

actinic keratoses, diagnosis, keratinocyte

Abstract

Actinic keratosis (AK) is one of the most frequent tumors of the skin; the diagnosis is basically clinical although in some cases it may be difficult to distinguish it from other keratinocytic or even melanocytic neoplasms when it presents in pigmented form. Over the years several clinical classifications and scores to objectify the burden of disease have been created. In this review the most frequent scores and classification systems are summarized along with dermoscopic criteria that allow diagnosis with greater sensitivity and specificity.

 

 

Author Biographies

Claudio Conforti, Istituto dermopatico dell’Immacolata, IDI-IRCCS, Dermatological Research Hospital, Rome, Italy.

Istituto dermopatico dell’Immacolata, IDI-IRCCS, Dermatological Research Hospital, Rome, Italy.

Chiara Retrosi, Istituto dermopatico dell’Immacolata, IDI-IRCCS, Dermatological Research Hospital, Rome, Italy.

Istituto dermopatico dell’Immacolata, IDI-IRCCS, Dermatological Research Hospital, Rome, Italy.

Carmen Cantisani, Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy

Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy

Giovanni Di Lella, Istituto dermopatico dell’Immacolata, IDI-IRCCS, Dermatological Research Hospital, Rome, Italy.

Istituto dermopatico dell’Immacolata, IDI-IRCCS, Dermatological Research Hospital, Rome, Italy.

Luca Fania, Istituto dermopatico dell’Immacolata, IDI-IRCCS, Dermatological Research Hospital, Rome, Italy.

Istituto dermopatico dell’Immacolata, IDI-IRCCS, Dermatological Research Hospital, Rome, Italy.

Roberta Rotunno, Istituto dermopatico dell’Immacolata, IDI-IRCCS, Dermatological Research Hospital, Rome, Italy.

Istituto dermopatico dell’Immacolata, IDI-IRCCS, Dermatological Research Hospital, Rome, Italy.

Iris Zalaudek, Dermatology Clinic, Maggiore Hospital, Piazza Ospitale 1, Trieste, Italy

Dermatology Clinic, Maggiore Hospital, Piazza Ospitale 1, Trieste, Italy

Giovanni Pellacani, Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy

Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy

References

Lee KJ, Soyer HP. Cutaneous keratinocyte cancers of the head and neck: Epidemiology, risk factors and clinical, dermoscopic and reflectance confocal microscopic features. Oral Oncol. 2019 Nov;98:109-117. doi: 10.1016/j.oraloncology.2019.09.019. Epub 2019 Oct 1. Erratum in: Oral Oncol.2020 Mar;102:104514. PMID: 31585338.

Conforti C, Beninati E, Dianzani C. Are actinic keratoses really squamous cell cancer? How do we know if they would become malignant? Clin Dermatol. 2018 May-Jun;36(3):430-432. doi: 10.1016/j.clindermatol.2017.08.013. Epub 2017 Aug 31. PMID: 29908585.

Spencer J. Understanding actinic keratosis: epidemiology, biology, and management of the disease. J Am Acad Dermatol. 2013 Jan;68(1 Suppl 1):S1. doi: 10.1016/j.jaad.2012.10.006. PMID: 23228300.

Siegel JA, Korgavkar K, Weinstock MA. Current perspective on actinic keratosis: a review. Br J Dermatol. 2017 Aug;177(2):350-358. doi: 10.1111/bjd.14852. Epub 2016 Aug 8. PMID: 27500794.

Saenz-Sardà X, Carrato C, Pérez-Roca L, Puig L, Ferrándiz C, Ariza A, Fernández-Figueras MT. Epithelial-to-mesenchymal transition contributes to invasion in squamous cell carcinomas originated from actinic keratosis through the differentiated pathway, whereas proliferation plays a more significant role in the classical pathway. J Eur Acad Dermatol Venereol. 2018 Apr;32(4):581-586. doi: 10.1111/jdv.14514. Epub 2017 Oct 5. PMID: 28796927.

Fernandez Figueras MT. From actinic keratosis to squamous cell carcinoma: pathophysiology revisited. J Eur Acad Dermatol Venereol. 2017 Mar;31 Suppl 2:5-7. doi: 10.1111/jdv.14151. PMID: 28263020

Filosa A, Filosa G. Actinic keratosis and squamous cell carcinoma: clinical and pathological features. G Ital Dermatol Venereol. 2015 Aug;150(4):379-84. Epub 2015 Jun 23. PMID: 26099352.

Olsen EA, Abernethy ML, Kulp-Shorten C, et al. A double-blind, vehiclecontrolled study evaluating masoprocol cream in the treatment of actinic keratoses on the head and neck. J Am Acad Dermatol. 1991;24(5 Pt 1):738-743.

Sinclair R, Baker C, Spelman L, Supranowicz M, MacMahon B. A review of actinic keratosis, skin field cancerisation and the efficacy of topical therapies. Australas J Dermatol. 2021 May;62(2):119-123. doi: 10.1111/ajd.13447. Epub 2020 Aug 25. PMID: 32840870; PMCID: PMC8247342.

Dirschka T, Pellacani G, Micali G, Malvehy J, Stratigos AJ, Casari A, Schmitz L, Gupta G; Athens AK Study Group. A proposed scoring system for assessing the severity of actinic keratosis on the head: actinic keratosis area and severity index. J Eur Acad Dermatol Venereol. 2017 Aug;31(8):1295-1302. doi: 10.1111/jdv.14267. Epub 2017 May 3. PMID: 28401585.

Dréno B, Cerio R, Dirschka T, Nart IF, Lear JT, Peris K, de Casas AR, Kaleci S, Pellacani G. A Novel Actinic Keratosis Field Assessment Scale for Grading Actinic Keratosis Disease Severity. Acta Derm Venereol. 2017 Oct 2;97(9):1108-1113. doi: 10.2340/00015555-2710. PMID: 28536731.

Schmitz L, Broganelli P, Boada A. Classifying Actinic Keratosis: What the Reality of Everyday Clinical Practice Shows Us. J Drugs Dermatol. 2022 Aug 1;21(8):845-849. doi: 10.36849/JDD.6704. PMID: 35946975.

Zalaudek I, Giacomel J, Argenziano G, Hofmann-Wellenhof R, Micantonio T, Di Stefani A, Oliviero M, Rabinovitz H, Soyer HP, Peris K. Dermoscopy of facial nonpigmented actinic keratosis. Br J Dermatol. 2006 Nov;155(5):951-6. doi: 10.1111/j.1365-2133.2006.07426.x. PMID: 17034524.

Zalaudek I, Ferrara G, Leinweber B, Mercogliano A, D'Ambrosio A, Argenziano G. Pitfalls in the clinical and dermoscopic diagnosis of pigmented actinic keratosis. J Am Acad Dermatol. 2005 Dec;53(6):1071-4. doi: 10.1016/j.jaad.2005.08.052. PMID: 16310072.

Peris K, Micantonio T, Piccolo D, Fargnoli MC. Dermoscopic features of actinic keratosis. J Dtsch Dermatol Ges. 2007 Nov;5(11):970-6. English, German. doi: 10.1111/j.1610-0387.2007.06318.x. Epub 2007 Oct 1. PMID: 17908179.

Jindal R, Chauhan P, Shirazi N. Rosette or Four Dot Signs in Dermoscopy: a Non-specific Observation. Dermatol Pract Concept. 2022 Apr 1;12(2):e2022069. doi: 10.5826/dpc.1202a69. PMID: 35646433; PMCID: PMC9116560.

Zalaudek I, Giacomel J, Schmid K, Bondino S, Rosendahl C, Cavicchini S, Tourlaki A, Gasparini S, Bourne P, Keir J, Kittler H, Eibenschutz L, Catricalà C, Argenziano G. Dermatoscopy of facial actinic keratosis, intraepidermal carcinoma, and invasive squamous cell carcinoma: a progression model. J Am Acad Dermatol. 2012 Apr;66(4):589-97. doi: 10.1016/j.jaad.2011.02.011. Epub 2011 Aug 11. PMID: 21839538.

Moscarella E., Rabinovitz H., Zalaudek I., Piana S., Stanganelli I., Oliviero M.C. Dermoscopy and reflectance confocal microscopy of pigmented actinic keratoses: a morphological study. J Eur Acad Dermatol Venereol. 2015;29:307–314.

Ring C, Cox N, Lee JB. Dermatoscopy. Clin Dermatol. 2021 Jul-Aug;39(4):635-642. doi: 10.1016/j.clindermatol.2021.03.009. Epub 2021 Mar 19. PMID: 34809768.

Conforti C, Giuffrida R, de Barros MH, Resende FSS, Cerroni L, Zalaudek I. Dermoscopy of a single plaque on the face: an uncommon presentation of cutaneous sarcoidosis. Dermatol Pract Concept. 2018 Jul 31;8(3):174-176. doi: 10.5826/dpc.0803a04. PMID: 30116658; PMCID: PMC6092068.

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Published

2024-08-07

Issue

Vol. 14 No. S1 (2024): 2024 Vol 14, S1| Actinic Keratosis Today

Section

Review

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Copyright (c) 2024 Claudio Conforti, Chiara Retrosi, Carmen Cantisani, Giovanni Di Lella, Luca Fania, Roberta Rotunno, Iris Zalaudek, Giovanni Pellacani

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Dermatology Practical & Conceptual applies a Creative Commons Attribution License (CCAL) to all works we publish (http://creativecommons.org/licenses/by-nc/4.0/). Authors retain the copyright for their published work.

How to Cite

1.
Conforti C, Ambrosio L, Retrosi C, et al. Clinical and Dermoscopic Diagnosis of Actinic Keratosis. Dermatol Pract Concept. 2024;14(S1):e2024147S. doi:10.5826/dpc.1403S1a147S

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