Clinico-Pathologic Profile of a Cohort of Patients with Actinic Keratosis in a Tertiary Center in Romania

TL;DR

This study examines the clinical and histopathological features of actinic keratosis in elderly patients in Romania, emphasizing the importance of early detection and proper diagnosis.

Contribution

The study provides a detailed clinicopathological analysis of actinic keratosis in a Romanian population, highlighting the correlation between histological grades and clinical features.

Findings

Actinic keratosis was most common in elderly patients with hypertrophic lesions and moderate dysplasia (KIN II).

Higher KIN grades correlated with more severe pleomorphism, solar elastosis, and inflammatory response.

The study supports the use of non-invasive diagnostic tools for early detection and better management of actinic keratosis.

Abstract

Actinic keratoses are the most common precancerous lesions in the elderly population, and can sometimes be misdiagnosed as squamous cell carcinoma, which requires a different, often invasive, management, with possible risks of local complications. Our retrospective study analyzes the demographic, clinical and histopathological profile of a group of 58 patients with actinic keratoses surgically excised in the plastic surgery department of a tertiary center in Bucharest, Romania, highlighting the heterogeneity of histological subtypes, as well as the need for clinical pathological correlations in order to stratify patients into risk groups and to facilitate the choice of the best therapeutic option. Furthermore, the study highlights the continued need for early detection, the use of adequate photoprotection and the monitoring of patients with comorbidities that may increase the risk of developing AK/squamous cell carcinoma in situ.

Background/Objectives: Actinic keratosis (AK) is considered to be the most common form of in situ carcinoma and typically arises on skin that has been chronically exposed to ultraviolet radiation. The need for early diagnosis, using non-invasive methods, has allowed for a non-surgical approach to these conditions with a significant impact on the quality of life of patients. Methods: A retrospective study was conducted on 58 patients diagnosed with AK who underwent surgical excision at a tertiary center in Bucharest, Romania between 2018 and 2023. Clinical parameters (age, sex, lesion size, anatomical location, comorbidities) and histopathological variables (AK subtype, KIN grade, pleomorphism, solar elastosis, inflammatory infiltrate) were analyzed. Statistical associations between histological findings and clinical features were assessed using Fisher’s exact test. Conclusions: The study confirmed a predominance of AK among elderly patients, with hypertrophic lesions and moderate dysplasia (KIN II) being most common. Higher KIN grades correlated significantly with more severe pleomorphism, solar elastosis, and inflammatory response, suggesting progressive UV-induced skin damage. The findings underscore the importance of clinicopathological correlation for risk stratification and support the integration of non-invasive diagnostic tools to improve early detection and management of AK.

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