Dr. Sarma's Dermpath: Actinic Keratosis- Cases, Diagnostic clues and Variations

8/2/2019 Dr. Sarma's Dermpath: Actinic Keratosis- Cases, Diagnostic clues and Variations

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Dr Sarmas Dermpath

Deba P Sarma, MD

Dermatopathologist, Lakeside Hospital, Omaha, NE

Actinic keratosis

- Cases- Clues to diagnosis- Variations


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M 79, right sideburn


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Comment

Compact keratin on top.

Dysplastic basal cells. ( Remember: Normal basal cells in verruca

vulgaris and seborrheic keratosis).

Actinic dermal change

Diagnosis: Actinic keratosis(Solar keratosis)


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M 81, dorsum, left hand


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Diagnosis:

Cutaneous horn overlying actinickeratosis (Hypertrophic actinickeratosis)


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M 57, nose, keratotic lesion

Left half of the epidermis shows normal keratin ( with normallymaturing epidermis), right half shows hyperkeratosis, parakeratosis,compact keratin (with dysplastic epidermis maturing abnormally)

Normal keratin, atrophic epidermis, dermal actinic change


7/21

Dysplastic area (look at the basal cells showingenlargement and pleomorphism)

Dysplastic area (look at the basal cells showingenlargement and pleomorphism)


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Comment

To diagnose actinic keratosis, you need to seekeratosis (hyperkeratosis and parakeratosis) overlyingdysplastic epidermis and actinic degeneration of thedermis.

Epidermal cell atypia + dermal actinic change =Actinic change.

Epidermal atypia + dermal actinic change + keratosis= Actinic keratosis.

Do not diagnose actinic keratosis if dermis does notshow actinic degeneration.


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M 67, forehead

- Hyperkeratosis, acanthosis, suprabasal acantholysis.- Dermal solar degeneration.

Atypical basal keratinocytes, acantholysis, dyskeratotic cells in the clefts


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Atypical basal keratinocytes, acantholysis, dyskeratotic cells in the clefts

Basal atypical keratinocytes, acantholysis, clefts, dyskeratotic cells


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Clinical:

Common epidermal lesion in chronically sun-

exposed skin: head and neck, forearms and dorsalhands.

Pathology:

Basal keratinocyte atypia extending along the hairand varying degree of atypia in the suprabasalkeratinocytes.

Parakeratosis, hyperkeratosis, acanthosis,pseudoepitheliomatous hyperplasia.

Suprabasal acantholysis with clefting or bulla

formation (pseudoglandular appearance).


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M 68, scalp


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Diagnosis:

Hypertrophic actinic keratosis.

Note:

A. Hyperkeratosis, parakeratosis, acanthosis.

B. Dysplasitc pleomorphic basal keratinocytes.

C. Dermal actinic degeneration.


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Actinic keratosis: Diagnostic clues

Deba P Sarma, MD

Omaha

Compact hyperkeratosis, dysplastic basal cells, dermal actinic change


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Higher magnification

Compact hyperkeratosis


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Dysplastic basal cells

Actinic keratosis: Diagnostic clues

Compact hyperkeratosis

Dysplastic basal cells

Actinic dermal change

REMEMBER:No hyperkeratosis and no actinic dermal change = No actinic keratosis


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Actinic keratosis variations

Deba P Sarma, MD

Omaha

Actinic keratosis is a sun-induced dysplastic epidermal lesion.Dysplasia starts at the basal layer.Look at the dysplastic basal cells.Dysplastic squamous cells making abnormal non-flaky keratin on top.Dermis shows solar degeneration.


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Actinic keratosis, atrophic type

Actinic keratosis, hypertrophic type


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Actinic keratosis, acantholytic type

Actinic keratosis, lichenoid type


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Actinic keratosis, bowenoid type

Actinic keratosis, bullous type


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References:

1. Sarma DP, Olivier M, Goldsman C, MillikanLE(1985):Beta-2 microglobulin as a marker of

malignant epithelial tumors of the skin. J Surg

Oncol 29:61-65. PMID: 3887039 [PubMed -

indexed for MEDLINE]

2. Sarma DP, Sharma P(2006)Bullous solarkeratosis. The Internet J Dermatol, 4(1).

Indexed by Google Scholar.
http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=3887039&itool=pubmed_briefhttp://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=3887039&itool=pubmed_briefhttp://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=3887039&itool=pubmed_briefhttp://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=3887039&itool=pubmed_briefhttp://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijd/vol4n1/bullous.xmlhttp://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijd/vol4n1/bullous.xmlhttp://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijd/vol4n1/bullous.xmlhttp://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijd/vol4n1/bullous.xmlhttp://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijd/vol4n1/bullous.xmlhttp://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=3887039&itool=pubmed_briefhttp://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=3887039&itool=pubmed_briefhttp://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=3887039&itool=pubmed_brief

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Dr. Sarma's Dermpath: Actinic Keratosis- Cases, Diagnostic clues and Variations