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Actinic Keratosis

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Dermatological Cryosurgery and Cryotherapy

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Abstract

Actinic keratoses are sun-induced in situ epidermal tumors characterized by the proliferation of abnormal keratinocytes. Clinical lesions present as erythematous, rough, scaly, hyperkeratotic papules or plaques on sun exposed areas. However, a subclinical component may be present due to invasion of tumor cells down the hair follicle, sweat duct, or at the base of the epidermis without affecting keratinization and causing clinical change. Lesions with an increased risk of progression to invasive squamous cell carcinoma should be biopsied. The two main treatment approaches for actinic keratoses are field-directed and lesion-directed therapy. Cryotherapy is the most common form of treatment of actinic keratoses. Here, we present the technique, application, adverse events, efficacy, limitations, and compare cryotherapy versus other treatment modalities. Overall, cryotherapy coupled with field-directed therapy provides the best clinical outcome for the treatment of AKs.

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References

  1. Unna PG. Die Histopathologie der Hautkrankheiten. Berlin: Verlag von August Hirschwald; 1894. p. 719–24.

    Google Scholar 

  2. Heaphy Jr MR, Ackerman AB. The nature of solar keratosis: a critical review in historical perspective. J Am Acad Dermatol. 2000;43(1):138–50.

    Article  PubMed  Google Scholar 

  3. Society for Investigative Dermatology, American Academ of Dermatology Association. The burden of skin diseases, 2005. Available from: http://www.lewin.com/~/media/lewin/site_sections/publications/april2005skindisease. Accessed 20 Mar 2014.

  4. Salache SJ. Epidemiology of AK and squamous cell carcinoma. J Am Acad Dermatol. 2000;42:S4–7.

    Article  Google Scholar 

  5. Gupta AK, Inniss K, Wainwright R, et al. Interventions for AKs (protocol for a cochrane review). Chichester: The Cochrane Library; 2004.

    Google Scholar 

  6. Marks R, Ponsford MW, Selwood TS, Goodman G, Mason G. Non-melanotic skin cancer and solar keratoses in Victoria. Med J Aust. 1983;2:619–22.

    CAS  PubMed  Google Scholar 

  7. Goldberg LH, Joseph AK, Tschen JA. Proliferative actinic keratosis. Int J Dermatol. 1994;33:341–5.

    Article  CAS  PubMed  Google Scholar 

  8. Marks R, Rennie G, Selwood TS. Malignant transformation of solar keratoses to squamous cell carcinoma. Lancet. 1988;1:795–7.

    Article  CAS  PubMed  Google Scholar 

  9. Graham JH. Precancerous lesions of the skin. Prim Care. 1976;2:699–716.

    Google Scholar 

  10. Fuchs A, Marmur E. The kinetics of skin cancer: progression of AK to squamous cell carcinoma. Dermatol Surg. 2007;33:1099–101.

    CAS  PubMed  Google Scholar 

  11. Dodson JM, DeSpain J, Hewett JE, Clark DP. Malignant potential of AKs and the controversy over treatment. Arch Dermatol. 1991;127:1029–31.

    Article  CAS  PubMed  Google Scholar 

  12. Ceilley RI, Jorizzo JL. Current issues in the management of AK. J Am Acad Dermatol. 2013;68:S28–38.

    Article  PubMed  Google Scholar 

  13. Lee AD, Jorizzo JL. Optimizing management of AK and photodamaged skin: utilizing a stepwise approach. Cutis. 2009;84:169–75.

    PubMed  Google Scholar 

  14. Balkrishnan R, Cayce KA, Kulkarni AS, et al. Predictors of treatment choices and associated outcomes in AKs: results from a national phycisian survey study. J Dermatol Treat. 2006;17:162–6.

    Article  Google Scholar 

  15. Poziomczyk CS, Koche B, Dornelles MA, Dornelles SIT. Pain evaluation in the cryosurgery of AKs. An Bras Dermatol. 2011;86(4):645–50.

    Article  PubMed  Google Scholar 

  16. Chapter 37: Dermatologic surgery Andrew’s disease of the skin: clinical dermatology. 11th edn. p. 863–87.

    Google Scholar 

  17. Kuflik EG. Cryosurgery. In: Bolognia JL, Jorizzo JL, Rapini RP, editors. Dermatology. New York: Elsevier; 2007.

    Google Scholar 

  18. Andrews MD. Cryosurgery for common skin conditions. Am Fam Physician. 2004;69(10):2365–72.

    PubMed  Google Scholar 

  19. Feldman SR, Fleischer AB, Williford PM, Jorizzo JL. Destructive procedures are the standard of care for treatment of AKs. J Am Acad Dermatol. 1999;40:43–7.

    Article  CAS  PubMed  Google Scholar 

  20. Jorizzo JL, Carney PS, Ko WT, Robbins P, Weinkle SH, Werschler WP. Treatment options in the management of AK. Cutis. 2004;74 Suppl 6:9–17.

    PubMed  Google Scholar 

  21. Nashan D, Meiss F, Muller M. Therapeutic strategies for AKs- a systematic review. Eur J Dermatol. 2013;23(1):14–32.

    CAS  PubMed  Google Scholar 

  22. Chiarello SE. Full-face cryo-(liquid nitrogen) peel. J Dermatol Surg Oncol. 1992;18:329–32.

    Article  CAS  PubMed  Google Scholar 

  23. Chairello SE. Cryopeeling (extensive cryosurgery) for the treatment of AKs: an update and comparison. Dermatol Surg. 2000;26(8):728–32.

    Article  Google Scholar 

  24. Management of AK. Drug Ther Bull 2013;7:81–4.

    Google Scholar 

  25. Abadir DM. Combination of topical 5-fluorouracil with cryotherapy for treatment of AKs. J Dermatol Surg Oncol. 1983;9(5):403–5.

    Article  CAS  PubMed  Google Scholar 

  26. Jorizzo J, Weiss J, Vamvakias G. One week treatment with 0.5% fluorouracil cream prior to cryosurgery in patients with AKs: a double blind, vehicle-controlled, long term study. J Drugs Dermatol. 2006;5:133–9.

    CAS  PubMed  Google Scholar 

  27. Buckhart CG, Buckhart CN. Ice cream headaches with cryotherapy of AKs. Int J Dermatol. 2006;45:1116–7.

    Article  Google Scholar 

  28. Lubritz RR, Smolewski SA. Cryosurgery cure rate of AKs. J Am Acad Dermatol. 1982;7:631–2.

    Article  CAS  PubMed  Google Scholar 

  29. Thai KE, Fergin P, Freeman M, et al. A prospective study of the use of cryosurgery for the treatment of AKs. Int J Dermatol. 2004;43:687–92.

    Article  PubMed  Google Scholar 

  30. Goldberg LH, Kaplan B, Vergilis-Kalner I, Landau J. Liquid nitrogen: temperature control in the treatment of AK. Dermatol Surg. 2010;36(12):1956–61.

    Article  CAS  PubMed  Google Scholar 

  31. Krawtchenko N, Roewert-Huber J, Ulrich M, Mann I, et al. A randomized study of topical 5% imiquimod vs topical 5-fluorouracil vs cryosurgery in immunocompetent patients with AKs: a comparison of clinical and histological outcomes including 1-year follow up. Br J Dermatol. 2007;157 Suppl 2:34–40.

    Article  CAS  PubMed  Google Scholar 

  32. Kaufmann R, Spelman L, Weightman W, et al. Multicenter intraindividual randomized trial of topical methyl aminolaevulinate-photodynamic therapy vs cryotherapy for multiple AKs on the extremities. Br J Dermatol. 2008;158:994–9.

    Article  CAS  PubMed  Google Scholar 

  33. Szeimies RM, Karrer S, Radakovic-Fijan S, et al. Photodynamic therapy using topical methyl 5-aminolaevulinate-photodynamic therapy compared with cryotherapy for AK: a prospective randomized study. J Am Acad Dermatol. 2002;47(2):258–62.

    Article  CAS  PubMed  Google Scholar 

  34. Morton C, Campell S, Gupta G, et al. Intraindividual, right-left comparison of topical methyl aminolaevulinate-photodynamic therapy and cryotherapy in subjects with AKs: a multicentre, randomized controlled study. Br J Dermatol. 2006;155:1029–36.

    Article  CAS  PubMed  Google Scholar 

  35. Freeman M, Vinciullo C, Francis D, et al. A comparison of photodynamic therapy using topical methyl aminolaevulinate (Metvix) with single cycle cryotherapy in patients with AK: a prospective randomized study. J Dermatol Treat. 2003;14:99–106.

    Article  CAS  Google Scholar 

  36. Zane C, Facchinetti E, Rossi MT, Specchia C, Ortel B, Calzavara-Pinton P. Cryotherapy is preferable to ablative CO2 laser for the treatment of isolated actinic keratoses of the face and scalp: a randomized clinical trial. Br J Dermatol. 2014;170(5):1114–21.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Dermatology, Derm Surgery Associates, Houston, TX, USA

    Leonard H. Goldberg MD, Diane Trieu MD & Anna Drosou MD

Authors
  1. Leonard H. Goldberg MD
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  2. Diane Trieu MD
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  3. Anna Drosou MD
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Corresponding author

Correspondence to Leonard H. Goldberg MD .

Editor information

Editors and Affiliations

  1. Dermatology Treatment & Research Center, Dallas, Texas, USA

    William Abramovits

  2. Eastern Dermatology and Pathology, Morehead City, North Carolina, USA

    Gloria Graham

  3. The Unit of Plastic Surgery, Carmel Medical Center, Haifa, Israel

    Yaron Har-Shai

  4. St Anna Hospital, University of Ferrara, Ferrara, Italy

    Renata Strumia

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© 2016 Springer-Verlag London

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Goldberg, L.H., Trieu, D., Drosou, A. (2016). Actinic Keratosis. In: Abramovits, W., Graham, G., Har-Shai, Y., Strumia, R. (eds) Dermatological Cryosurgery and Cryotherapy. Springer, London. https://doi.org/10.1007/978-1-4471-6765-5_128

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  • DOI: https://doi.org/10.1007/978-1-4471-6765-5_128

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-6764-8

  • Online ISBN: 978-1-4471-6765-5

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