Actinic keratosis (AK) (solar keratosis) is a squamous cell carcinoma confined to the epidermis. The lesions are common, sun-induced, and increase in number with age. Most lesions remain superficial. Lesions that extend more deeply to involve the papillary and/or reticular dermis are termed squamous cell carcinoma (SCC).
The potential for change cannot be predicted by clinical signs or histologic characteristics. Thick lesions are worrisome. Patients with AKs need periodic evaluation and usually repetitive treatments to prevent the development of aggressive cancers. Individuals with light complexions are more susceptible than those with dark complexions. Years of sun exposure are required to induce sufficient damage to cause lesions. Actinic keratoses may undergo spontaneous remission if sunlight exposure is reduced, but new lesions may appear.[55] Patients often present with lesions that were first noticed during the summer, suggesting that the lesions may become more active after sunlight exposure. Immunosuppression is a risk factor. SCC is up to 65 times as likely to develop in transplant patients as controls. Lesions appear 2 to 4 years after transplantation and increase in frequency.
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