Actinic Keratosis

Question 1

Risk of 1 AK developing into a SCC. over 10 years if left untreated

Answer 1

10.2%

Question 2

Epidemiology

Answer 2

caucasions, exposure to UV, sun damanged skin of head, neck, trunk, and arms

Question 3

Pathogenesis

Answer 3

Prolonged UV light exposure –> damaged skin cells that cannot repair themselves, some can spontaneously resolve

Question 4

Early AK lesions

Answer 4

slight scale w or without erythema. classic presentation: scaly erythematous papule

Question 5

Advanced AK lesions

Answer 5

thicker with erythema and hyperkeratosis

Question 6

Cryosurgery for AKs

Answer 6

1-3 freeze thaw cycles, painful, can lead to blisters and itching. Crusting can take 2-3 weeks to resolve.

Question 7

Complications of Cryosurgery for AKs

Answer 7

scarring and post inflammatory pigment changes

Question 8

Photodynamic therapy for AKs

Answer 8

aminolevulinic acid (ALA), for nonhyperkeratotic areas on face and scalp, blue light to activate the ALA, causing apoptosis of neoplastic cells, 24-48 hrs sun protection afterwards. s/e erythema and scaling. Adverse reaction is like a severe sunburn,

Question 9

5FU

Answer 9

Disrupts RNA synthesis, on face: 1-2x a day x 2 weeks. Up to 6 weeks other locations. Not if pregnant. S/e: erythema, burning, itching

Question 10

Imiquimod

Answer 10

Immunomodulator, 5% for 2.5cm area. Usually every night x 2 weeks, then 2 weeks off, then 2 more weeks of therapy. s/e erythema, crusting, pruritus

Question 11

Ingenol mebutate (Picato)

Answer 11

green tea polyphenol, for face daily x 3 days. chest x 2 days. erythema and crusting.

Question 12

Diclofenac gel

Answer 12

cox2 inhibitor, BID x 60-90 days. s/e erythema and crusting

Question 13

Consider this when patients have numerous AKs

Answer 13

topical therapy

Question 14

cryotherapy side effects

Answer 14

blistering, discomfort, potential scarring

Question 15

5FU

Answer 15

better efficacy, more side effects