Actinic Keratosis Workup

  • Author: James M Spencer, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Mar 19, 2012
 

Laboratory Studies

Blood work is not indicated.

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Procedures

A skin biopsy is indicated to confirm the diagnosis and to rule out invasive squamous cell carcinoma for suspicious or more advanced lesions (ie, those with more pronounced hyperkeratosis, increased erythema, induration or nodularity).[33, 34] A biopsy is also indicated for recurrent lesions or those that are unresponsive to therapy.

Fluorescence with the use of a photosensitizing drug (methyl ester of 5-aminolevulinic acid [ALA], a precursor of protoporphyrin) commonly used during photodynamic therapy (PDT) has been described as a diagnostic tool for actinic keratosis.[20] Areas of involvement, including occult areas of abnormal skin, emit a pink fluorescence with a Wood lamp or photodynamic therapy lamp.[20]

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Histologic Findings

Actinic keratosis is characterized by dysplasia and architectural disorder of the epidermis.[15] Keratinocytes of the basal layer are abnormal and are variable in size and shape; cellular polarity is altered, and nuclear atypia is seen.[15] These alterations may extend upward to the granular layer, which may be thinned. Overall, the epidermis exhibits hyperkeratosis and parakeratosis, and irregular acanthosis may be present.[15] In general, hair follicles, sebaceous glands, and apocrine and eccrine ducts are not involved.[15]

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Contributor Information and Disclosures
Author

James M Spencer, MD  Professor of Clinical Dermatology, Mount Sinai School of Medicine, New York; Private Practice, Spencer Dermatology, St Petersburg, Florida

James M Spencer, MD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Dermatological Association, American Medical Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, and International Society for Dermatologic Surgery

Disclosure: Graceway Pharmaceutical Honoraria Speaking and teaching; Sanofi Aventis Honoraria Consulting; Medicis Grant/research funds Independent contractor; Peplin Grant/research funds Independent contractor

Coauthor(s)

Michelle Henry, MD  Resident Physician, Department of Dermatology, Mount Sinai School of Medicine of New York University

Disclosure: Nothing to disclose.

Specialty Editor Board

Kelly M Cordoro, MD  Assistant Professor of Clinical Dermatology and Pediatrics, Department of Dermatology, University of California, San Francisco School of Medicine

Kelly M Cordoro, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Association of Professors of Dermatology, Dermatology Foundation, Medical Society of Virginia, National Psoriasis Foundation, Society for Pediatric Dermatology, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Mary Farley, MD  Dermatologic Surgeon/Mohs Surgeon, Anne Arundel Surgery Center

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, James Fulton Jr, MD, PhD, and Amy Lynn Basile, DO, MPH, to the development and writing of this article. The authors and editors of eMedicine also gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.

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Courtesy of Hon Pak, MD, and reviewed by Ross Levy, MD.
Actinic keratosis during treatment with topical 5-fluorouracil. Courtesy of Hon Pak, MD, and reviewed by Ross Levy, MD.
Actinic keratosis right after treatment with topical 5-fluorouracil. Courtesy of Hon Pak, MD, and reviewed by Ross Levy, MD.
Erythematous, scaly lesions on the temple area, typical of actinic keratosis.
 
 
 
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