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Multiple Actinic Keratoses (solar keratoses or sunspots)



Actinic keratoses are pre-cancerous lesions that develop on sun-exposed areas of skin. They most commonly appear as rough, dry and scaly patches on the skin.

Although the risk of progression of an individual AK to invasive SCC has been estimated to be (less than 1 in 1000/year). the risk increases if:

  • Multiple thick AKs

  • Past history of non‐melanoma skin cancer

  • Extensive actinic damage

  • Tender enlarging lesion(s)

  • Immunosuppressed Patients (e.g. organ transplant)

Choice of Treatment?

The most appropriate management plan should be determined by the Clinical circumstances;

· should take into account the extent (single or multiple lesions)

· site/distribution

· duration

· presence of symptoms & severity of lesions

· other associated risk factors for skin cancer


Patient’s factors:

· preferences and ability to comply with treatment

· comorbidities

· quality-of-life


Treatment

· If any contraindications

· Previous treatment trialed & their side effects

· Cost & availability of the treatment

· Doctor’s experience


Treatment options when there are multiple actinic keratoses present (known as field treatment): used individually or in combination:

o Salicylic acid

o Topical retinoids

o 5-Flourouracil cream

o Imiquimod cream

o Diclofenac gel

o Ingenol mebutate gel

o Photodynamic therapy (PDT), including daylight PDT

o Superficial or medium depth Chemical peels

o Laser therapy- ablative or nonablative laser

o systemic retinoids may be justified in very high-risk patients, such as organ transplant recipients

o Nicotinamide- in high risk patients, some evidence about ~ 25% reduction of NMSC at 12 months

It is not uncommon for the lesions to recur which is why repeat treatment is sometimes necessary with any of the above options. A referral to a specialist dermatologist may be necessary to discuss/ give the best treatment.


Dr. Heba Jibreal

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