“Actinic keratoses (AK) do not require histologic diagnosis if typical clinical findings are present.”
In cases of resistance to therapy and clinically unclear findings, a biopsy (tissue biopsy) should be obtained. This can be done by incisional biopsy form of tissue removal in which only a portion of the suspicious finding is removed) or by curettage (“scraping”).
1st order
- “Cryosurgery (application of cryogenics in surgery) should be offered in a lesion-directed manner for single or multiple Olsen grade I-III actinic keratoses (AK) in immunocompetent individuals.” With cryotherapy, patients remain in remission longer; grade III keratoses remitted 80% with cryotherapy, but only 60% with CO2 laser. With cryotherapy, 53 of 73 patients remained in remission (73%), compared with only 14 of 64 (22%) of laser-treated patients; follow-up was one year.
- “Surgical removal of grade I-III AK according to Olsen (e.g., by curettage, shallow ablation, or complete excision) should be offered for single lesions in immunocompetent and immunosuppressed patients.”[EK].
- Laser procedures
- Ablative laser procedures: Treatment with ablative laser procedures may be offered for single or multiple Olsen grade I-III AKs and field cancerization in immunocompetent patients.
- Nonablative laser procedures: Treatment with nonablative laser procedures may be offered for single or multiple AK of grades I-II according to Olsen.
Note: Any suspicion of progressive carcinoma in situ, Bowen’s disease, or other differential diagnoses requires histopathologic (fine tissue) evaluation.
