Dr Todd Schlesinger: Morphology, Immunosuppression Affect Actinic Keratosis Outcomes

Actinic keratosis outcomes can be affected by several variables, including chronic sun exposure, mutational burden, and immunosuppression. These concerning lesions need to be treated to minimize progression risk, noted Todd Schlesinger, MD, FAAD, director, Dermatology and Laser Center of Charleston and Clinical Research Center of the Carolinas.

Transcript

Why do 10% of patients with actinic keratosis develop skin cancer?

I think to reverse that question. If you're gonna say close to 90% of patients with actinic keratosis don't develop skin cancers, the other 10% do, or approximately. So, actinic keratoses are small keratotic lesions that develop typically on skin that has been chronically exposed to the sun—occurs a little more in our subpopulation that are older, more Caucasian, more males than females. These are lesions that are concerning, and they all should be treated to minimize the risk of progression. That's the main concern.

As far as who develops skin cancer and who doesn't, I think one thing that can be argued is that the amount of sun exposure someone's had over a lifetime can affect that. But since actinic keratoses and squamous cell carcinomas are tumors that rely on their mutational burden to develop tumors, which means a number of mutations or the types of mutations that are present—such as p53 or Notch mutations—in these tumors sort of determine what direction they're going to go in.

So I think more often than not it’s the morphology of the individual lesion that helps decide whether it's going to go toward cancer, and also the patient's level of immunosuppression. A patient who may be older, or may be on immunosuppressive therapy of one kind or another, may be a solid organ transplant recipient or other transplant, might have a higher risk as well. So I think it's a complex interplay between the tumor cells, the pending tumor cells in actinic keratosis, and the patient's immune response.