32 3 Eyelid Neoplasms

ACTINIC KERATOSIS T hese lesions may be single or multiple on chronically sun-exposed skin. They ap pear as dry, rough, scaly lesions that are stable but can rarely disappear spontaneously. Epidemiology and Etiology ● Age: Older than 40 years; rarely younger than 30 years ● Gender: Higher incidence in males ● Etiology: Sun exposure over time in a fair-skinned white population results in ac tinic keratosis. History ● Extensive sun exposure in youth ● Lesions present for months Examination ● Rough, slightly elevated, skin-colored or light brown lesions with hyperkeratotic scale ( Fig. 3-2 ) Special Considerations ● It is estimated that one squamous cell carci noma will develop per 1000 actinic keratoses. Synonym: solar keratosis

Laboratory Tests ● Pathologic evaluation if biopsied Pathophysiology

● Repeated solar exposure results in damage to the keratinocytes by the cumulative effects of ultraviolet radiation. Treatment ● Prevention through early and lifelong use of sunscreen ● Excise nodular lesions and submit for pathologic evaluation. ● Most flat lesions respond to liquid nitrogen or topical application of 5% 5-fluorouracil cream over a few days to weeks. ● Topical imiquimod cream has also been ap proved for the treatment of actinic keratosis. ● These three treatments (liquid nitrogen, 5-fluorouracil, and imiquimod) must be used with caution around the eye and should be avoided in lesions at or near the lid margin. Prognosis ● Some actinic keratoses may disappear spon taneously, but others remain for years unless treated. ● Incidence of squamous cell carcinoma de veloping in these lesions is unknown but has been estimated to be one squamous cell carci noma in every 1000 actinic keratoses.

Differential Diagnosis ● Squamous cell carcinoma ● Discoid lupus

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