Introduction
Actinic keratoses (AK) are keratotic lesions presenting on chronically ultraviolet-exposed skin. The rate of malignant progression of a single AK to squamous cell carcinoma (SCC) remains uncertain, with reports ranging from 0.025%–20%.1,2 Patients receiving long-term immunosuppressive medications are at higher risk of developing AK.3 The estimated prevalence of AK is 19%–24% of individuals aged >60 years in the UK.3 Research suggests between 25%–70% of AK may spontaneously regress in a 1–4 year period.3 A Dutch qualitative study highlighted that some primary care clinicians’ principal approach to managing AK was treatment with cryosurgery, or referral to secondary care with patient-driven follow-up care.4 This article aims to inform GPs on the management of AK based on the British Association of Dermatologists (BAD) guidelines, the authors’ opinions on effective virtual consultations on AK, and when to refer patients to secondary care.
Clinical presentation of actinic keratosis
AK are often asymptomatic but can be sore or itchy. The presentation of AK is classified into three grades according to the BAD.3 Grade 1 (mild) AK are minimally scaly patches, grade 2 (moderate) are moderately scaly patches, and grade 3 (severe) are hyperkeratotic lesions.3 Confluent areas of AK (field changes) signifies extensive actinic damage.3 International guidelines have classified four different patient groups for treatment: patients with single AK lesions (1–5 AK per field or body region), patients with multiple AK lesions (≥6 AK lesions on one body region or field), patients with field cancerisation (≥6 AK lesions in one body region or field), and patients with concomitant …
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