Actinic keratosis –
a common skin condition that can lead to skin cancer

Actinic keratosis is one of the most common pre-cancerous skin conditions. How prevalent is it in the UK?

Actinic keratosis (AK) is one of the most common diagnoses made by dermatologists, with an estimated prevalence of over 23% in the UK population for those aged 60 and over, according to the National Institute for Health Care and Excellence (NICE). In Europe, its prevalence is estimated to be about 13%.

Indeed, AK is the most common precancerous skin condition. In this regard, it is estimated that 40-80% of squamous cell carcinomas (SCCs) – the second most common form of skin cancer – develop from AK.

What steps are taken to determine the presence of AK on the skin?
Actinic keratoses (AKs) are skin lesions that typically develop on the most sun-exposed areas of the body: the head (especially the scalp of balding men), neck and arms. AKs can appear either on their own or in patches, and typically look like small, crusty patches of skin that can be red, white, pink or a combination of colours. Some lesions can be very small, or almost invisible, but can be identified by their rough texture.

In order to determine the presence of AKs on the skin, it is important to get your skin checked by a professional regularly so that they can undertake a thorough visual examination and look for signs of AKs and other skin conditions. Healthcare professionals (HCPs) are likely to diagnose AKs by looking and feeling your skin, but sometimes it is necessary to perform a biopsy to eliminate the possibility of SCCs.

Are there any factors that contribute to an increased risk of developing AK?
Exposure to accumulated ultraviolet (UV) radiation over the years is mostly responsible for the development of actinic keratosis, which is why incidence gets higher with age. This accumulation results from sunbathing, using tanning beds or from working or playing sports outdoors.

Other factors that can increase the risk of developing AKs are having a fair skin type, being immunosuppressed and having genetic syndromes involving alterations in DNA repair mechanisms, such as albinism.

What are the current treatment options available to patients and how have they evolved in the last decade?
Currently, there are two kinds of treatment options available: lesion-directed therapies applied by an HCP, such as cryosurgery (freezing and destroying abnormal tissue), laser therapy, surgery, and field-directed therapies, such as photodynamic therapy (PDT) – treatment where the patient is exposed to a special light to destroy AKs – and topical therapies that are administrated by the patient.

While lesion-directed therapies can be used for the treatment of individual and visible AKs or in cases when patients cannot follow at-home treatments, they may be inefficient for patients with numerous lesions or field cancerisation, where broader areas of skin are affected by visible and invisible actinic damage. For these patients, topical therapies may be a suitable choice, because they treat the entire affected area.

Dermatologists will take into account different factors, such as: the number of lesions, where they are located, the age of the patient and their overall health. Options include either techniques such as surgery, cryotherapy or laser or topical medications. Either way, a good treatment should be fast, efficient and convenient, allowing for good adherence.

What is the impact on patient outcomes when patients are diagnosed later rather than sooner?
Even though AKs are not immediately harmful themselves, as I mentioned before, AKs have the potential to evolve into SCCs. Although it is difficult to determine which ones will have a malignant transformation, this risk increases with every year that the AK lesion is left untreated. In this regard, some studies cite an increased risk that is as high as 16% per lesion-year.

AK Global Day is an opportunity for people to learn more about this common but unknown condition and to tell others

What steps can people take to minimise their risk of developing AK?
Protecting yourself from the sun is essential to prevent the appearance of actinic keratosis and slow down its progression. Following some measures strictly is key to keeping actinic keratoses under control: use sunscreen daily (SPF 50), wear a hat and clothing that covers your full body, and avoid peak sun hours and artificial sunlight, such as sun beds or tanning lamps.

It is also important to examine your skin regularly in order to recognise any unusual changes as they appear. If you notice any suspicious changes (for instance, a new actinic keratosis lesion has appeared or one of the old ones has changed in any way, either in size or shape, or it bleeds), you must make an appointment to see a dermatologist so you can get checked right away.

What has new data revealed about the level of AK awareness in the UK?
In April this year, a survey was undertaken by Almirall that included 2,496 participants over 35 years of age from the US and several European countries, including the UK. The survey revealed that many people don’t know about actinic keratosis and do not check their skin regularly. In this sense, that data that has been collected is clear: 85% of respondents are unaware of the existence of AK and more than half of respondents (57.73%) don’t ever get their skin checked by an HCP.

In the UK, the percentage of people who are aware of AK is even lower: 92.4% do not know what this condition is. Also, very few people get their skin checked, with up to 84.80% of respondents stating that they never see an HCP about this. The data indicates that there is still much work to be done to improve people’s knowledge about this condition.

What is being done to raise awareness of AK globally?
In 2022, we established the first Global Day focused on actinic keratosis and supported the Skin Cancer Month in May. For this, we partnered with Euromelanoma, a project that aims to promote and share information on skin cancer prevention, early diagnosis and treatment. The project is led by a network of European dermatologists who generously give up their time to serve this cause.

AK Global Day took place on 24 May this year. How was this day marked around the world?
AK Global Day is an opportunity for people to learn about this common but unknown condition and share this knowledge with family and friends, especially those who are older.  This year’s Global Day focused on raising awareness of actinic keratosis and the importance of regular skin checks, both at home and by HCPs. Alongside presenting the findings of the survey mentioned before, the campaign involved a range of activities to educate people about the warning signs of AK, the importance of skin checks, and how to identify lesions for themselves and their relatives and caregivers.