0521779407-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:45
Acromegaly Actinic Keratosis 15■Visual field changes signify tumor growth
■Patients require lifelong observation
■Increased risk of colonic polyps and perhaps colon cancer
■Osteoarthritis
■Increased risk of early mortality (cardiac) if not cured (normal IGF-I
levels)Actinic Keratosis......................................
MICHAEL DACEY, MD and JEFFREY P. CALLEN, MD
REVISED BY JEFFREY P. CALLEN, MDhistory & physical
■also called solar keratosis, senile keratosis
■This disorder is the earliest clinical manifestation of squamous cell
carcinoma
■disease of the older adult with chronic sun-damaged skin
■risk factors: fair skin, blue eyes, red or blonde hair, years of ultraviolet
radiation exposure through work (e.g., farmers, mail carriers, etc.) or
through leisure activities (tanning bed use, tanning)
■Patients who are organ transplant recipients are prone to developing
many actinic keratoses, and malignant transformation (progression)
is much more common in this setting.
■sun-exposed distribution – most often on the head, neck, forearms
or dorsal hands of men, and these areas plus the legs in women
■poorly circumscribed erythematous macules, papules, or plaques,
several millimeters to a centimeter in diameter
■adherent, “sandpaper-like” scale
■may form a hypertrophic, verrucous surface and become a horn
■occasionally hyperpigmented
■may be tender
tests
■The diagnosis is clinical.
■If the diagnosis is in question, a biopsy may be performed.
differential diagnosis
■Bowen’s disease (squamous cell cancer in situ)
■Squamous cell cancer
■Basal cell cancer
■Seborrheic keratosis – sharp demarcation, stuck on appearance, ver-
rucous surface