Should all Actinic Keratoses be treated?
The diagnosis of AKs is primarily clinical, with the seasoned dermatologist having little difficulty recognizing their appearance. They emerge as ill-defined pink to skin-colored, scaly papules and small plaques on chronically sun-exposed areas of light-skinned individuals (Figure 1). They are most commonly located on the face, ears, balding scalp, extensor forearms, and dorsal hands. Studies have confirmed that histological diagnosis is in agreement with clinical suspicion more than 90 percent of the time, with only 1 in 25 lesions clinically consistent with AK revealing occult invasive disease.[4] Interestingly, while studies have shown a reduction in incidence of both AKs and SCC through sun protection, there has not been a randomized, controlled study demonstrating a decrease in SCC frequency with treatment of AKs. In practice, the relationship between AKs and SCC and the process of AK progression to invasive SCC are difficult to characterize precisely. Within the dermatological li
