Glogau R G
University of California, San Francisco, USA.
J Am Acad Dermatol. 2000 Jan;42(1 Pt 2):23-4. doi: 10.1067/mjd.2000.103339.
Actinic keratoses occasionally progress to invasive skin cancer. The clinician-dermatologist ideally would like to know which lesions are at individual risk. Various investigators have attempted to answer this problem through a variety of clinical research applications including counting individual lesions in populations at risk, in the general population, and by examining insurance claims data and extrapolating incidence figures.
The purpose of the study was to ascertain the range of risks for progression of actinic keratoses to invasive skin cancer.
Five clinical research studies were reviewed that covered a period from 1988 to 1998. Published risk of progression of actinic keratoses to invasive squamous cell carcinoma for individual lesions ranged from 0.025% to 16% per year. Extrapolation from these clinical studies suggests a rate of risk of progression of actinic keratoses to invasive squamous cell carcinoma of approximately 8% taken as an average among the cited statistical rates in the studies reviewed.
Although the rate of progression of actinic keratoses to invasive squamous cell carcinoma statistically occurs at a low percentage rate ( approximately 10%), the problem for the clinician is that the risk over a broad population does not aid in determining the risk factor for the individual lesion. Hence the decision to treat is made on related clinical factors such as history of persistence, age of patient, discomfort, extent of coexisting photodamage, tolerance for morbidity of therapy, and history of skin cancer.
光化性角化病偶尔会发展为浸润性皮肤癌。皮肤科医生理想情况下希望了解哪些病变存在个体风险。许多研究人员试图通过各种临床研究应用来回答这个问题，包括对高危人群、普通人群中的个体病变进行计数，以及检查保险理赔数据并推断发病率。
本研究的目的是确定光化性角化病发展为浸润性皮肤癌的风险范围。
回顾了五项临床研究，时间跨度从1988年至1998年。已发表的单个光化性角化病病变发展为浸润性鳞状细胞癌的风险为每年0.025%至16%。从这些临床研究推断，在回顾的研究中引用的统计率中，光化性角化病发展为浸润性鳞状细胞癌的平均风险率约为8%。
虽然从统计学角度来看，光化性角化病发展为浸润性鳞状细胞癌的发生率较低（约10%），但临床医生面临的问题是，总体人群的风险无助于确定单个病变的风险因素。因此，治疗决策是基于相关临床因素做出的，如病变持续时间、患者年龄、不适程度、并存光损伤的程度、对治疗所致不适的耐受程度以及皮肤癌病史。
