Thamm Janis Raphael, Schuh Sandra, Welzel Julia
Department of Dermatology and Allergology, University Hospital Augsburg, Germany.
Dermatol Pract Concept. 2024 Sep 1;14(3 S1):e2024146S. doi: 10.5826/dpc.1403S1a146S.
Actinic keratosis (AK) is considered a chronic skin disease mostly caused by long-term exposure to UV radiation and other risk factors such as immunosuppression, leading to an individual susceptibility for skin cancer manifestation. The treatment of AK is laborious and costly, and the incidence of skin cancer is forecasted to double until the year 2030 in an aging society.Risk factors in AK for malignant transformation in cutaneous squamous cell carcinoma (cSCC) are not fully understood, but studies suggest that histological features, such as atypia in the basal epidermal third and basal proliferation (PRO score) in AK play a pivotal role for development of malignancy. As the clinical appearance of AK does not correlate with the risk for malignancy, guidelines suggest treating every single AK lesion upon diagnosis. Skin imaging techniques, such as line-field confocal optical coherence tomography (LC-OCT) can help to provide an individual holistic follow-up for AK lesions by non-invasive visualization of atypia and basal proliferation. A follow-up for patients with AK may be critical for treatment success in terms of strengthening therapy adherence. When AK presents therapy refractory, cSCC manifests in nearly 30% of the cases after several years. Patients with AK suffering from field cancerization and immunosuppression are susceptible for a severe course of disease including metastasis and high mortality rates. Those vulnerable subgroups benefit from close skin cancer screening, early adequate treatment and chemoprevention, such as niacinamide or acitretin. Skin cancer prevention is substantial. Primary prevention should include chemical and physical UV-light protection and avoidance of indoor tanning. Secondary prevention is essential in high-risk populations, such as fair skin type elderly men and STORs. Tertiary prevention should comprise adequate treatment strategies to prevent therapy resistance, reoccurrence and cSCC, especially when field cancerization and immunosuppression are present.
光化性角化病（AK）被认为是一种慢性皮肤病，主要由长期暴露于紫外线辐射以及免疫抑制等其他风险因素引起，导致个体易患皮肤癌。AK的治疗既费力又昂贵，在老龄化社会中，预计到2030年皮肤癌的发病率将翻倍。AK发展为皮肤鳞状细胞癌（cSCC）的恶性转化风险因素尚未完全明确，但研究表明，AK的组织学特征，如基底表皮三分之一处的异型性和基底增殖（PRO评分）在恶性肿瘤的发展中起关键作用。由于AK的临床表现与恶性风险不相关，指南建议在诊断时对每一个AK皮损进行治疗。皮肤成像技术，如线场共聚焦光学相干断层扫描（LC-OCT），可以通过对异型性和基底增殖进行无创可视化，帮助为AK皮损提供个体化的整体随访。对AK患者进行随访对于提高治疗依从性从而取得治疗成功可能至关重要。当AK对治疗难治时，数年后近30%的病例会出现cSCC。患有场癌化和免疫抑制的AK患者易患包括转移和高死亡率在内的严重病程。这些易感亚组受益于密切的皮肤癌筛查、早期充分治疗和化学预防，如烟酰胺或阿维A。皮肤癌预防至关重要。一级预防应包括化学和物理防晒以及避免室内晒黑。二级预防在高危人群中至关重要，如皮肤白皙的老年男性和器官移植受者。三级预防应包括适当的治疗策略，以防止治疗抵抗、复发和cSCC，特别是在场癌化和免疫抑制存在的情况下。
