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Actinic (Solar) Keratosis

 

AK should routinely be managed in primary care. 

We have not included much on management here as PCDS have a useful summary of how to manage this condition in primary care: (includes grades, pictures, treatment and referral advice) https://www.pcds.org.uk/files/gallery/AK_guidelines_Macrh_2020.pdf1

 

 

SKIN CARE ADVICE:

  • Although less than 1/1000 of AK progress to SCC the presence of multiple AKs (7 or more) the risk of one transforming in 10 years is 10%1.

Important to stress skin cancer prevention to patient to prevent new lesions/SCC

  • Wearing regular sunscreen- factor 50 and 4-5 star UVA rating
  • Protective clothing – long sleeved, trousers and wide brimmed hat
  • Limit sun exposure 11am-3pm

See leaflet: https://patient.info/cancer/skin-cancer-types/preventing-skin-cancer

 

 

CONSIDER REFERRAL:(For consideration of Photodynamic Therapy (PDT))

  • Young patients (<35 years)
  • Evidence of extensive UV damage
  • Immunosuppressed
  • Past history of skin cancer
  • Periocular AK
  • Xeroderma pigmentosum
  • Failure to respond to primary care management
  • Possibility of SCC (refer via 2ww)

 

 

KEY ADDITIONAL POINTS: (In addition to PCDS guidelines)

Treatment of actinic keratosis does not result in reduction of progression to SCC2 but it will help highlight those not responding to normal therapy.

  • 3% diclofenac with Hyaluronic acid (Solaraze) – useful for thin lesions/wide areas
  • 5% 5-FU (Efudix) – For areas up to 500cm2. Assess treatment outcome 1-2 months after 4-6 week treatment complete. Ignore any sustained inflammation until 3 month review. Caution in poorly healing areas (e.g. legs) – may need supervision or lower dose (e.g. OD for 3/52 periods)
  • 0.5% 5-FU + 10% Salicyclic acid (Actikerall) – useful for thick hyeprkeratotic lesions - small areas up to 252
  • Imiquimod 5% (Aldara)– for areas up to 25cm2
  • Imiquimod 3.75% (Zylclara)- Licensed for lesions on face and scalp upto 25cm2
  • Caution re excluding SCC with ear lesions as if they are SCC they are more likely to metastasize.

 

 

USEFUL LEAFLETS:

Actinic keratosis: https://www.bad.org.uk/shared/get-file.ashx?id=66&itemtype=document

5FU cream: https://www.bad.org.uk/shared/get-file.ashx?id=187&itemtype=document

Imiquimod cream: https://www.bad.org.uk/shared/get-file.ashx?id=209&itemtype=document

 

REFERENCES:

  1. https://www.pcds.org.uk/files/gallery/AK_guidelines_Macrh_2020.pdf1
  2. Berker, D., McGregor, J., Mohd Mustapa, M.F., Exton, L.S., & Hughes, B.R. (2017). British Association of Dermatologists’ guidelines for the care of patients with actinic keratosis 2017. British Journal of Dermatology, 176.

 

Review date                 March 2022

Next review due           March 2023

Reviewing GP              Dr Madeleine Attridge