Actinic keratosis (Solar

keratosis)
Deba P Sarma, MD
Omaha
 M 57, nose, keratotic lesion

Left half of the epidermis shows normal keratin ( with normally

maturing epidermis), right half shows hyperkeratosis, parakeratosis,
compact keratin (with dysplastic epidermis maturing abnormally)
Normal keratin, atrophic epidermis, dermal actinic change
Dysplastic area (look at the basal cells showing
enlargement and pleomorphism)
Dysplastic area (look at the basal cells showing
enlargement and pleomorphism)
 Comment

 To diagnose actinic keratosis, you need to see keratosis

( hyperkeratosis and parakeratosis) overlying dysplastic epidermis
and actinic degeneration of the dermis.

 Epidermal cell atypia + dermal actinic change = Actinic change.

 Epidermal atypia + dermal actinic change + keratosis = Actinic

keratosis.

 Do not diagnose actinic keratosis if dermis does not show actinic

degeneration.

 Do not diagnose actinic keratosis if there is no abnormal keratin. You

have to see keratosis before you call actinic keratosis.