The State of the Art in the Treatment of Actinic Keratosis and Field Cancerization - A Narrative Review

Q: What is actinic keratosis (AK) and why is it clinically important?

AK is considered the early phase of cutaneous squamous cell carcinoma and is one of the most common epithelial skin lesions. Its importance lies in its potential progression to invasive disease, especially in the setting of field cancerization.

Q: What factors increase the risk of developing AK?

Risk factors include age over 45, male gender, history of nonmelanoma skin cancer, outdoor work for more than 6 hours per day, skin type I/II, immunosuppression, tanning bed use, baldness, photosensitizing drugs in chronic therapy, alcohol consumption, and solid organ transplant recipients on chronic immunosuppression.

Q: How does field cancerization affect progression risk in AK patients?

Field cancerization reflects a broader UV-damaged area with subclinical atypical keratinocytes. The frequent presence of multiple lesions lowers the chance of spontaneous regression and increases the cumulative risk of progression to cutaneous squamous cell carcinoma.

Sep 23, 2026

Uploaded by Mary Man

Actinic keratosis (AK) is a common epithelial skin lesion considered the early phase of cutaneous squamous cell carcinoma, with an estimated global prevalence around 14%. The annual risk of progression ranges from 0 to 0.53%, while individual-lesion spontaneous regression occurs in about 23% of cases. However, multiple lesions within field cancerization reduce regression likelihood and increase cumulative SCC risk. This narrative review summarizes the most effective lesion-directed and field-directed therapies, including personalized, combined, sequential, and emerging options.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages14

Reading Time35 min

AccessFree to download

Introduction

Materials and Methods

Review The State of the Art in the Treatment of Actinic Keratosis and Field Cancerization: A Narrative Review Andrea Paradisi 1,2,*, Enrico Bocchino 1,2, Maria Mannino 1,2, Giulio Gualdi 3, Alessandra D’Amore 1,2, Daniele Omar Traini 1,2 and Ketty Peris 1,2 Academic Editor: Elisabeta Candrea Received: 25 July 2025 Revised: 21 August 2025 Accepted: 28 August 2025 Published: 3 September 2025 Citation: Paradisi, A.; Bocchino, E.; Mannino, M.; Gualdi, G.; D’Amore, A.; Traini, D.O.; Peris, K. The State of the Art in the Treatment of Actinic Keratosis and Field Cancerization: A Narrative Review. J. Pers. Med. 2025, 15, 421. [https://doi.org/10.3390/](https://doi.org/10.3390/)[ ](https://doi.org/10.3390/)jpm15090421 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://creativecommons.org/](https://creativecommons.org/)[ ](https://creativecommons.org/)[licenses/by/4.0/](licenses/by/4.0/)) . 1 Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; [enrico.bocchino01@icatt.it](enrico.bocchino01@icatt.it) (E.B.); [alessandra.damore@policlinicogemelli.it](alessandra.damore@policlinicogemelli.it) (A.D.); [danieleomar.traini01@icatt.it](danieleomar.traini01@icatt.it) (D.O.T.); [ketty.peris@unicatt.it](ketty.peris@unicatt.it) (K.P.) 2 UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli—IRCCS, 00168 Rome, Italy 3 Department of Medicine and Aging Science and Dermatologic Clinic, University “G. D’Annunzio”, 66100 Chieti, Italy; [giuliogualdi@libero.it](giuliogualdi@libero.it) * Correspondence: [andrea.paradisi@policlinicogemelli.it](andrea.paradisi@policlinicogemelli.it) Abstract Actinic keratosis (AK) is considered the early phase of a squamous cell carcinoma (SCC) and represents one of the most common epithelial skin lesions, with an estimated global prevalence of approximately 14% . An estimated annual risk of progression has been reported with a range from 0 to 0.53% . Although spontaneous regression of individual AK lesions has been described in approximately 23% of cases, the frequent presence of multiple lesions, usually in the broader context of field cancerization, significantly diminishes the likelihood of regression and contributes to a higher cumulative risk of progression to SCC. The aim of the present narrative review was to provide an overview of the current evidence of the most effective available lesion-directed and field-directed treatments for actinic keratoses, on the personalized, combined, or sequential approach, as well as on the emerging therapeutic options. Keywords: actinic keratosis; treatment; field cancerization 1. Introduction Actinic keratosis (AK) is considered the early phase of a cutaneous squamous cell carcinoma (cSCC) and represents one of the most common epithelial skin lesions, with an estimated global prevalence of approximately 14%[1] . Risk factors for AK development include age >45 years, male gender, a history of nonmelanoma skin cancer, outdoor work for more than 6 h a day, skin type I/II, solar lentigines, immunosuppression, use of tanning beds, baldness, use of photosensitizing drugs in chronic therapies, alcohol consumption and immunosuppression [2,3] . In particular, solid organ transplant recipients treated with chronic immunosuppressive therapy have an 80% lifetime risk of developing AK and a 30% risk of having at least five AKs [4] . Clinically, AK presents as an erythematous papule or plaque, scaly, usually <1 mm thick, located in sun-exposed areas; it can be asymptomatic, pruritic, or occasionally tender to palpation [5] . AKs are frequently classified according to the Olsen grading system, wherein grade I lesions are characterized by minimal hyperkeratosis, bein

FAQs

What is actinic keratosis (AK) and why is it clinically important?

AK is considered the early phase of cutaneous squamous cell carcinoma and is one of the most common epithelial skin lesions. Its importance lies in its potential progression to invasive disease, especially in the setting of field cancerization.

What factors increase the risk of developing AK?

Risk factors include age over 45, male gender, history of nonmelanoma skin cancer, outdoor work for more than 6 hours per day, skin type I/II, immunosuppression, tanning bed use, baldness, photosensitizing drugs in chronic therapy, alcohol consumption, and solid organ transplant recipients on chronic immunosuppression.

How does field cancerization affect progression risk in AK patients?

Field cancerization reflects a broader UV-damaged area with subclinical atypical keratinocytes. The frequent presence of multiple lesions lowers the chance of spontaneous regression and increases the cumulative risk of progression to cutaneous squamous cell carcinoma.

Sep 23, 2026

Uploaded by Mary Man