Epidemiology and Risk Factors of Actinic Keratosis - What is New for The Management for Sun-Damaged Skin

Sep 21, 2026

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Actinic keratosis (AK) is a chronic, UV-driven skin disease that arises over long-term sun exposure and is intensified by risk factors such as immunosuppression, increasing susceptibility to skin cancer. Treatment is demanding and projected to become more burdensome as skin cancer incidence rises in aging populations. Malignant transformation toward cutaneous squamous cell carcinoma (cSCC) is linked to histologic indicators, including atypia in the basal epidermal third and PRO score, while clinical appearance alone poorly predicts risk. Non-invasive imaging (e.g., LC-OCT) may enable individualized monitoring by visualizing atypia and basal proliferation, supporting adherence. Patients with field cancerization and immunosuppression have higher rates of therapy resistance, progression, metastasis and mortality. Evidence supports primary, secondary, and tertiary prevention, including UV protection, early treatment, screening, and chemoprevention strategies.

LanguageEnglish

CategoryResearch & Report

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Pages15

Reading Time38 min

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ABSTRACT

Introduction – Epidemiology

Epidemiology and Risk Factors of Actinic Keratosis. What is New for The Management for Sun-Damaged Skin Janis Raphael Thamm1, Sandra Schuh1, Julia Welzel1 1 Department of Dermatology and Allergology, University Hospital Augsburg, Germany Key words: actinic keratosis, skin cancer, prevention, non-invasive imaging, PRO score Citation: Thamm JR, Schuh S, Welzel J Epidemiology and Risk Factors of Actinic Keratosis. What Is New for The Management for Sun-Damaged Skin. Dermatol Pract Concept. 2024;14(3)S1:e2024146S. DOI: [https://doi.org/10.5826/dpc.1403S1a146S](https://doi.org/10.5826/dpc.1403S1a146S) [Accepted:](Accepted: July 12)[ July 12](Accepted: July 12), [2024](2024); Published: September 2024 Copyright: ©2024 Thamm et al. This is an open-access article distributed under the terms of the Creative Commons AttributionNonCommercial License (BY-NC-4.0), [https://creativecommons.org/licenses/by-nc/4.0/](https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: Julia Welzel: Consulting fees from Almirall, Janssen, Lecture fees from Almirall, Novartis, Janssen, Leo, Boehringer Ingelheim, BMS, Travel Grant from Janssen, President of the German Dermatological Society. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Janis Thamm, MD, Department of Dermatology and Allergology, University Hospital Augsburg, Sauerbruchstr. 6, 86179 Augsburg, Germany. Phone: +498214007401 Fax: +[49821400177401 E-Mail: janis.thamm@uk-augsburg.de](49821400177401 E-Mail: janis.thamm@uk-augsburg.de) ABSTRACT Actinic keratosis (AK) is considered a chronic skin disease mostly caused by long-term exposure to UV radiation and other risk factors such as immunosuppression, leading to an individual susceptibility for skin cancer manifestation. The treatment of AK is laborious and costly, and the incidence of skin cancer is forecasted to double until the year 2030 in an aging society. Risk factors in AK for malignant transformation in cutaneous squamous cell carcinoma (cSCC) are not fully understood, but studies suggest that histological features, such as atypia in the basal epidermal third and basal proliferation (PRO score) in AK play a pivotal role for development of malignancy. As the clinical appearance of AK does not correlate with the risk for malignancy, guidelines suggest treating every single AK lesion upon diagnosis. Skin imaging techniques, such as line-field confocal optical coherence tomography (LC-OCT) can help to provide an individual holistic follow-up for AK lesions by non-invasive visualization of atypia and basal proliferation. A follow-up for patients with AK may be critical for treatment success in terms of strengthening therapy adherence. When AK presents therapy refractory, cSCC manifests in nearly 30% of the cases after several years. Patients with AK suffering from field cancerization and immunosuppression are susceptible for a severe course of disease including metastasis and high mortality rates. Those vulnerable subgroups benefit from close skin cancer screening, early adequate treatment and chemoprevention, such as niacinamide or acitretin. Skin cancer prevention is substantial. Primary prevention should include chemical and physical UV-light protection and avoidance of indoor tanning. Secondary prevention is essential in high-risk populations, such as fair skin type elderly men and STORs. Tertiary prevention should comprise adequate treatment strategies to prevent therapy resistance, reoccurrence and cSCC, especially when field cancerization and immunosuppression are present. Review | Dermatol Pract Concept. 2024;14(3)S1:e2024146S 1 Introduction – Epidemiology Actinic keratosis (AK) is characterized by the presence of atypical keratinocytes within the epidermal skin layer and is consid

FAQs

What major factors contribute to actinic keratosis development and skin cancer risk?

Actinic keratosis is mainly caused by long-term UV radiation exposure and is influenced by additional risk factors such as immunosuppression, which increases susceptibility to skin cancer manifestations.

Why does clinical appearance of actinic keratosis not reliably predict malignancy risk?

The document states that clinical appearance does not correlate with the risk for malignancy; therefore, guidelines recommend treating every AK lesion upon diagnosis.

How can non-invasive imaging support management and follow-up of actinic keratosis?

Techniques such as line-field confocal optical coherence tomography (LC-OCT) can provide non-invasive visualization of atypia and basal proliferation, enabling more individualized holistic follow-up and supporting therapy adherence.

Sep 21, 2026

Uploaded by Quinn