Actinic keratosis is an early in situ squamous cell carcinoma: a proposal for reclassification

@article{RwertHuber2007ActinicKI,
  title={Actinic keratosis is an early in situ squamous cell carcinoma: a proposal for reclassification},
  author={Joachim R{\"o}wert‐Huber and M J Patel and Tobias Forschner and Claas Ulrich and J{\"u}rgen Eberle and Helmut Kerl and Wolfram Sterry and E Stockfleth},
  journal={British Journal of Dermatology},
  year={2007},
  volume={156}
}
Summary The term actinic keratosis (AK) describes a sun‐induced, clinical erythematous lesion covered with scale, but does not provide an understanding of the biology or histopathology of the lesion. Cousequeutly, several classification systems for AK have been suggested, but as yet no cousensus has been reached. These systems strive to correlate the pathological and clinical features to better provide physcians with the most accurate information to enable correct decisions to be made regarding… 
From actinic keratosis to squamous cell carcinoma – answers to some open questions
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    The British journal of dermatology
  • 2019
TLDR
It is found that SCCs were associated with basal proliferation and not with the degree of upward cellular atypia of actinic keratoses (AKs), meaning that it is not possible to predict the histological extent of atypical keratinocytes by clinical assessment of the severity of hyperkeratosis.
From actinic keratosis to squamous cell carcinoma: pathophysiology revisited
TLDR
It is proposed that all AKs, regardless of the grade, should be carefully monitored and appropriately treated in clinical practice and the ideal treatment should be able to eradicate AK lesions and reverse the underlying field cancerization.
From actinic keratosis to squamous cell carcinoma: pathophysiology revisited.
TLDR
It is proposed that all AKs, regardless of the grade, should be carefully monitored and appropriately treated in clinical practice and the ideal treatment should be able to eradicate AK lesions and reverse the underlying field cancerization.
Actinic keratoses contiguous with squamous cell carcinomas are mostly non-hyperkeratotic and with severe dysplasia
TLDR
Investigating the thicknesses and degree of dysplasia of AKs contiguous with SCCs assuming these AKs represent the AKs that have undergone malignant transformation suggests malignant progression potential ofAKs regardless of thickness.
Current perspective on actinic keratosis: a review
TLDR
Improved agreement among clinicians on AK definition may improve management, and treatments should aim to decrease the risk of KC or facilitate KC diagnosis by reducing the potential for misidentification created when a KC appears in a field of AKs.
Actinic keratoses: what classification is useful to predict the risk of progression? PROs and cons
  • F. Rongioletti
  • Medicine
    Journal of the European Academy of Dermatology and Venereology : JEADV
  • 2019
TLDR
The histopathological grading assessment is important to evaluate progression risk and should be applied to classify all AKs from a histological ground to prevent malignant transformation into invasive squamous cell carcinomas.
Nonmelanoma skin cancer – from actinic keratosis to cutaneous squamous cell carcinoma
TLDR
New clinical, histomorphological, or molecular classifications are needed to be able to reliably stratify patients based on their individual risk, to prevent over‐ and undertreatment of an ever‐growing patient population and help develop treatment concepts based on individual patient needs.
Squamous Cell Carcinoma In Situ
TLDR
Novel topical agents have been developed which allow treatment of the complete actinically damaged fields and treatment includes among others surgical excision, cryotherapy, photodynamic therapy or immune response modifiers.
Actinic keratoses - a systemic review
TLDR
The term “field cancerization” characterises the presentation of multiple AK in UV-exposed areas and the risk for AK turning into a SCC is 6-10%.
New and current preventive treatment options in actinic keratosis
TLDR
Despite the increasing number of patients with AK developing into SCC, to date, there is still no clear suggestion of therapeutic strategy for AK and current treatment consists of a multitude of topical lesion‐directed or field‐directed therapies or a combination of both.
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References

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Actinic Keratoses and the Incidence of Occult Squamous Cell Carcinoma: A Clinical–Histopathologic Correlation
TLDR
In this study, about 1 in 25 clinically diagnosed AK lesions identified by board-certified dermatologist investigator(s) were occult early-stage squamous cell carcinomas on histologic assessment, a fact surmised by the medical community that until now had not been well quantified.
Histopathology of incipient intraepidermal squamous cell carcinoma ("actinic keratosis").
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  • Medicine
    Journal of the American Academy of Dermatology
  • 2000
TLDR
AKs are malignant neoplasms in evolution and demonstrate histologic and molecular genetic features of malignancy and it is proposed that the term actinic (solar) keratosis be eliminated.
Epidemiology of actinic keratoses and squamous cell carcinoma.
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  • Medicine
    Journal of the American Academy of Dermatology
  • 2000
TLDR
AKs are a reliable marker for those people most predisposed to development of an invasive SCC and are probably an early stage in a biologic continuum that culminates in SCC.
Pathology and pathobiology of the actinic (solar) keratosis
TLDR
Although historically AKs have been characterized as ‘precancerous’ or ‘premalignant’ lesions, the concept of AK existing on the same continuum as Bowen’s disease and squamous cell carcinoma has gained increasing support and acceptance in recent years.
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TLDR
Bowen's disease with invasive carcinoma (BD-CA) is not well recognized by clinicians because of its rarity and lack of specific clinical features.
Solar (actinic) keratosis is squamous cell carcinoma
TLDR
The issue of the fundamental character of solar keratosis became ever more bewildering when an American dermatologist, R.L. Sutton Jr, advanced a view contrary to the one propounded by Dubreuilh and given credence by Freudenthal, namely, conversion of the keratotic to carcinoma.
Inflammation is associated with progression of actinic keratoses to squamous cell carcinomas in humans
TLDR
It is observed that before actinic keratoses (AK) progress to SCCs they may become tender and inflamed, and histological examination shows that they are, in fact, S CCs.
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