Laboratory Studies

Blood work is not indicated.

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).^{[8, 9]}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.^[10]Areas of involvement, including occult areas of abnormal skin, emit a pink fluorescence with a Wood lamp or photodynamic therapy lamp.^[10]

Histologic Findings

Actinic keratosis is characterized by dysplasia and architectural disorder of the epidermis.^[1]Keratinocytes of the basal layer are abnormal and are variable in size and shape; cellular polarity is altered, and nuclear atypia is seen.^[1]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.^[1]In general, hair follicles, sebaceous glands, and apocrine and eccrine ducts are not involved.^[1]

Treatment & Management

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Media Gallery

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

of 4

Author

James M Spencer, MD Professor of Clinical Dermatology, Mount Sinai School of Medicine; Private Practice, Spencer Dermatology

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 Surgery, American Medical Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, International Society for Dermatologic Surgery

Disclosure: Received grant/research funds from Genentech for independent contractor; Received grant/research funds from DUSA for independent contractor; Received honoraria from Leo Pharmicuticals for review panel membership.

Coauthor(s)

Laura Jordan, DO, MA, MS, MLS Dermatology-Focus Traditional Rotating Intern, UH Regional Hospitals

Laura Jordan, DO, MA, MS, MLS is a member of the following medical societies: American Osteopathic College of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

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

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

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, Medical Society of Virginia, Society for Pediatric Dermatology, Women's Dermatologic Society, Association of Professors of Dermatology, National Psoriasis Foundation, Dermatology Foundation

Disclosure: Nothing to disclose.

Michelle Henry, MD Fellow in Procedural Dermatology, Department of Dermatology, Lahey Clinic, Harvard Medical School

Disclosure: Nothing to disclose.

Acknowledgements

Amy Lynn Basile, DO, MPH Sun Coast Hospital/Largo Medical Center, Largo, Florida

Disclosure: Nothing to disclose.

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

Disclosure: Nothing to disclose.

James Fulton Jr, MD, PhD Medical Director, Fulton Skin Institute

Disclosure: Nothing to disclose.