Iceberg sign in actinic keratosis neglecta caused by toning shampoo for blonde and white hair (original) (raw)

Dermoscopic features of actinic keratosis

JDDG, 2007

Actinic keratosis (AK) is a keratinocytic neoplasm that typically develops on sun-damaged skin of elderly individuals. Only a few reports so far have described the dermoscopic diagnostic features of AK, mainly focusing on facial nonpigmented AKs. A typical feature of facial non-pigmented AK is a composite pattern named "strawberry pattern", characterized by a background erythema/red pseudonetwork consisting of unfocused, large vessels located between the hair follicles, associated with prominent follicular openings surrounded by a white halo. Dermoscopic characteristics of pigmented AK on the face include multiple slate-gray to dark-brown dots and globules around the follicular ostia, annular-granular pattern and brown to gray pseudonetwork. Recognizing specific dermoscopic features of AK can be useful in guiding the clinician in the differential diagnosis of AK with melanocytic skin lesions such as LM and non-melanocytic lesions. Histopathologic examination should be performed whenever clinical and/or dermoscopic differential diagnosis is inconclusive.

Dermoscopy of actinic keratosis

In the realm of keratinocyte skin cancer, specific dermo-scopic patterns that are associated with different stages of progression have been identified, which allows for an improved clinical diagnosis and differentiation actinic keratosis, intraepidermal carcinoma (also commonly named Bowen's disease, squamous cell carcinoma in situ or intraepidermal carcinoma) and invasive squamous cell carcinoma. Moreover, in times of increasing availability of topical treatment options for actinic keratoses, the knowledge of specific patterns associated with different grades and subtypes aids in the treatment choice and monitoring of the treatment response.

A GP’s guide to actinic keratosis

2016

ctinic keratoses (AKs) are superficial, discrete, erythematous and scaly skin lesions. They are also known as solar keratoses or ‘sunspots’. AKs are found predominantly on sun-exposed areas such as the scalp, face and forearms.1 Globally, Australians have the highest rate of AK development, resulting in a prevalence of 40 to 60% among the Caucasian population above the age of 40 years.1,2 Not surprisingly, the treatment of AK often falls under the responsibility of GPs so it is important to be aware of the full range of available treatment options.

Dermoscopic and therapeutic aspects of actinic keratosis and intraepidermal carcinoma

Dermoscopic and therapeutic aspects of actinic keratosis and intraepidermal carcinoma, 2023

mong non-melanoma skin cancers, squamous cell carcinoma (SSC) ranks second after basal cell carcinoma. It can grow “de novo” or as a result of actinic keratosis (AK) foci and intraepidermal carcinoma (IEC) malignancy [1]. The aim is to familiarize practitioners with the use of dermoscopy in the diagnosis of AK and IEC. Patient A., 72 years old, went to the hospital with complaints about the presence of a single rash element on the right cheek and periodic itching. The lesion appeared many years ago, gradually increased in size and became covered with scales. The patient was often in the open sun for a long time without protection. Objectively, in the projection of the right cheek, an inhomogeneous pink spot up to 5 cm in size is observed with hyperkeratotic layers on the surface and signs of multiple injuries. On the periphery of the lesion, the erythema is more pronounced (fig. 1 A). Dermoscopy shows that the morphology of lesion is chaotic, with surface crusted scale on a background of a red vascular pseudonetwork, representing dilated vessels of the horizontal dermal plexus (fig. 1 B). The patient was diagnosed with AK and prescribed cryotherapy. On control examination, the area of the scar showed no features. The patient was recommended to avoid UV, use sunscreens, and attend follow-up visits once a year. Patient B., 46 years old, went to the hospital with complaints about the presence of a single rash element in the area of the upper pole of the cartilage of the right auricle. The rash appeared more than a year ago. It has been itching lately. Objectively, in the specified area an erythematous spot of 1 x 0.8 cm, oval in shape with peeling on the surface was seen (fig. 2 A). Dermoscopy reveals glomerular vessels in a random arrangement. Peripherally linear vessels are apparent, being the normal dermal plexus vessels at that location (fig. 2 B). On the basis of the clinical and dermoscopic features, IEC was diagnosed, and the lesion was treated by cryosurgery with uneventful recovery, follow-up visits once a year are recommended. Actinic keratosis typically represents as red scaly macules and plaques of chronically sun-exposed areas. Lesions can be single, located in different anatomical areas or multiple [2]. In case of insufficient or contradictory clinical data, the use of dermoscopy is recommended. When using this method, it is possible to see the signs of AK with greater reliability than when examined with the naked eye [3]. Different types of AK correspond to different dermoscopic patterns. Grade I AK is characterized by the presence of a red vascular pseudonetwork and single white scales, correlates with inflammation, causing the normal horizontal dermal plexus to have dilated and more evident vessels. Grade II is typified by dilated follicular openings filled with yellow-white keratotic masses, due to highly keratinized atypical squamous cells invading follicular infundibula, on a pink vascular background ("strawberry" pattern). Grade III is manifested by enlarged follicular openings filled with keratotic plugs and covered with scales on a white-yellow background, or severe hyperkeratosis, represented by white-yellow unstructured areas [4]. Polarized dermatoscopy can also reveal a sign of "clover" or "rosette" of the figure formed by four whitish dots surrounding the follicular opening [5]. Histological verification of AK is not required in the case of an obvious clinical picture [1]. Modern practice refers to IEC as a SCC in situ localized extragenitally. The probability of IEC progression in SCC varies between 3% and 5%. However, recent retrospective studies show the rate up to 16% [6]. Clinically, IEC is manifested by asymptomatic, well-delineated, solitary, erythematous focus. Typical localization is a place of prolonged insolation. It is 10–15 mm in size, prone to slow growth. The surface may be dry with peeling, or ulcerate and bleed. With the formation of the node, the appearance of pain, you should suspect progression to SCC. The diagnosis is usually made clinically and, if necessary, can be confirmed using dermatoscope and histopathology. In IEC, the characteristic feature is the glomerular vessels lesion distributed in the lesion [5]. Treatment AK and IEC includes destructive methods and topical medicine. Patients should be monitored at least once a year [7, 8].

Dermoscopy of Pigmented Actinic Keratosis of the Face: A Study of 232 Cases

Actas Dermo-Sifiliográficas

The diagnosis of pigmented actinic keratosis (PAK) is often challenging because of overlapping features with lentigo maligna. Objective: To investigate dermoscopic patterns of PA K according to their different evolutionary stages, and to correlate the pattern with clinical characteristics of the patients. Methods: Descriptive and analytical study of 232 PAK. Dermoscopic patterns were divided into two categories: the follicule surroundings' abnormalities (FSA) and follicular keratosis' abnormalities (FKA). Results: FSA and FKA dermoscopic patterns were related to male gender, except for star-like appearance, double white clods and dermoscopic horn (p ≤ 0.04). Rhomboidal, annular granular pattern, gray halo, white circle and double clods were dermoscopic pattern significantly related to xeroderma pigmentosum's type of skin. Based on the evolutionary stages of PAK, the jelly sign was significantly related to thin patches of PAK. Central crusts and scales were related to thick plaques and the star-like appearance to hypertrophic PAK. The presence of 2 or more dermoscopic signs in both FSA and FKA was noticed in 99.1% of lesions. Conclusions: The dermoscopic diagnosis of PA K vary according to the evolutionary stages of the disease, this will increase the diagnosis accuracy, with therapeutic implications.

Actinic keratosis: a clinical and epidemiological revision

Anais Brasileiros de Dermatologia, 2012

Actinic keratoses are benign intraepithelial skin neoplasms constituted by atypical proliferation of keratinocytes that may evolve to squamous cell carcinoma. They develop in photoexposed skin areas; they are induced mainly by ultraviolet radiation and are considered cutaneous markers of chronic exposure to sunlight. They develop mainly in adults and older, fair skinned individuals, and are the fourth most common cause of dermatologic consultation in Brazil. Damage to the apoptosis pathway in photoexposed epithelium favors cellular proliferation and the permanence of the lesions. In this revision, the authors assemble the main epidemiological data regarding this disease and suggest that strategies to identify risky phenotypes, early diagnosis, adequate treatment, clinical follow-up, stimulus to skin self examination, photoeducation and photoprotection should be promoted with the aim of avoiding the progression to malignancy and also the prevention and the diagnose of concomitant neoplasms also induced by ultraviolet radiation.

Dermoscopy of facial nonpigmented actinic keratosis

British Journal of Dermatology, 2006

Background The accuracy of clinical diagnosis of nonpigmented, facial actinic keratosis (AK) is often suboptimal, even for experienced clinicians. Objectives To investigate the dermoscopic features of nonpigmented AK located on the head/neck that may assist the clinical diagnosis. Methods Forty-one nonpigmented AKs on facial sites were examined by dermoscopy for any consistent underlying features. Lesions were gathered from skin cancer centres in Australia, Austria, Italy and the U.S.A. All cases were diagnosed histopathologically.

Actinic Keratosis: Rationale and Management

Dermatology and Therapy, 2014

Actinic keratoses (AKs) are common skin lesions heralding an increased risk of developing squamous cell carcinoma (SCC) and other skin malignancies, arising principally due to excessive ultraviolet (UV) exposure. They are predominantly found in fair-skinned individuals, and increasingly, are a problem of the immunosuppressed. AKs may regress spontaneously, remain stable or transform to invasive SCC. The risk of SCC increases for those with more than 5 AKs, and the majority of SCCs arise from AKs. The main mechanisms of AK formation are inflammation, oxidative stress, immunosuppression, impaired apoptosis, mutagenesis, dysregulation of cell growth and proliferation, and tissue remodeling. Human papilloma virus has also been implicated in the formation of some AKs. Understanding these mechanisms guides the rationale behind the current available treatments for AKs. One of the main principles underpinning the management of AKs is that of field cancerization. Wide areas of skin are exposed to increasing amounts of UV light and other environmental insults as we age. This is especially true for the head, neck and forearms. These insults do not target only the skin where individual lesions develop, but also large areas where crops of AKs may appear. The skin between lesions is exposed to the same insults and is likely to contain as-yet undetectable preclinical lesions or areas of dysplastic cells. The whole affected area is known as the 'field'. Management is therefore divided into lesion-directed and field-directed therapies. Current therapies include lesiondirected cryotherapy and/or excision, and topical field-directed creams: 5-fluorouracil, imiquimod, diclofenac, photodynamic therapy and ingenol mebutate. Combining lesion-and field-directed therapies has yielded good results Electronic supplementary material The online version of this article (and several novel therapies are under investigation. Treatment is variable and tailored to the individual making a gold standard management algorithm difficult to design. This literature review article aims to describe the rationale behind the best available therapies for AKs in light of current understanding of pathophysiology and epidemiology. A PubMed and MEDLINE search of literature was performed between

The importance of early diagnosis and treatment of actinic keratosis

Journal of the American Academy of Dermatology, 2013

Chronic, long-term sun exposure results in genetic changes in epidermal keratinocytes and the development of various skin lesions ranging from actinic keratosis (AK) to skin cancer. AK lesions may first appear as rough, scaly spots on sun-exposed skin, and, although most individual AK lesions do not become invasive cancers, the majority of invasive squamous cell carcinomas originate from AK. Genetic analysis demonstrates that ultraviolet radiationeinduced mutations and changes in gene expression are present in squamous cell carcinoma, AK, and clinically normal-appearing perilesional sun-exposed skin, which supports the progressive nature of keratinocyte transformation. The presence of certain clinical features, such as large size, ulceration, or bleeding, suggests an increased risk of disease progression. The risk is also increased by evidence of extensive solar damage, advanced age, and immunosuppression. Early diagnosis and consideration for treatment are indicated to clear actinically damaged sites and diminish the risk of invasive squamous cell carcinoma. ( J Am Acad Dermatol 2013;68:S20-7.)