High rate of malignant transformation in hyperkeratotic actinic keratoses

p53 immunoexpression in stepwise progression of cutaneous squamous cell carcinoma and correlation with angiogenesis and cellular proliferation

“…Only tumors growing on the dorsum of forearms, wrists or hands were selected because these are anatomical sites of heavy sun exposure. Thirty-six percent of lesions with features of hyperkeratotic SK, measuring less than 1 cm in diameter, at these locations, were demonstrated, by histological analysis, to be invasive SCC [20]. This clinical-pathological continuum makes upper limbs a convenient site for further study.…”

Cutaneous squamous cell carcinoma: a comprehensive clinicopathologic classification. Part One

“…21 The atypical cells do not reach full epidermal thickness and rarely extend down adnexal structures, except in advanced cases of the hypertrophic and bowenoid variants. 21,22 Some cases may show a lichenoid infiltrate with irregular acanthosis, basal layer degeneration, and Civatte bodies, closely resembling a benign lichenoid keratosis or lichenoid dermatitis, but with obvious keratinocyte atypia. 23 The atrophic variant has mild hyperkeratosis with a thinned epidermis and atypical keratinocytes exhibiting large, hyperchromatic nuclei in close apposition to one another.…”

“…[15][16][17][18]22,[26][27][28][29] If it were possible to identify the few lesions which will progress to invasion, the clinical and economic impact could be tremendous. AKs likely have three evolutionary possibilities: (1) spontaneous clearing, (2) persistence, and (3) progression into invasive SCC.…”

The importance of early diagnosis and treatment of actinic keratosis

“…23,26 In a study of 43 patients, histologic evaluation of 50 papular hyperkeratotic lesions less than 1 cm in diameter on the back of the hand, wrist, and arm identified high rates of malignancy. 27 Invasive SCC and in situ SCC were identified in 36% and 14% of these lesions, respectively, and many lesions had complex presentations of SCC together with proliferative AKs or with hyperkeratotic AKs. 27 Demographic and symptom data were collected prospectively before dermatologic evaluation of elderly patients enrolled in a teledermatology study.…”

“…27 Invasive SCC and in situ SCC were identified in 36% and 14% of these lesions, respectively, and many lesions had complex presentations of SCC together with proliferative AKs or with hyperkeratotic AKs. 27 Demographic and symptom data were collected prospectively before dermatologic evaluation of elderly patients enrolled in a teledermatology study. 28 After clinical and histologic assessment, a significant association was found between tenderness (P = .0066), change in size (P = .0008), and bleeding (P = .0356) and invasive SCC (n = 240) compared with AK (n = 441).…”