Precursor of Skin Cancer: The Importance of Assessing Actinic Keratosis

Author

Fiona Schmidt

The prevention of skin cancer due to precancerous lesions, like Actinic keratosis, is crucial. Since assessment and treatment are often based on visual examination, digital technology can support health professionals.

Actinic keratosis (AK) describes a precancerous lesion caused mainly by years of sun exposure and is also often referred to as solar keratosis (1). Since UV radiation is the leading risk factor for developing AK (sun, tanning beds), the lesions are frequently located on sun-exposed body parts, namely the head and the upper extremities, such as the hands. There are three types of skin cancer: melanoma (black skin cancer), basal cell carcinoma (BCC; white skin cancer), and squamous cell carcinoma (SCC). The patches of AK usually appear dry, scaly, and red, measure 1-2cm in size, and are not dangerous by themselves. However, it is the most common precursor for skin cancer, and if left untreated, the chance of these skin lesions turning into the second most common skin cancer, squamous cell carcinoma, is about 5-10% (3). A rare type of AK includes pigmented actinic keratosis, which can mimic lesions similar to melanoma, so precise differentiation and diagnosis are significant for further treatment (2).

Experts expect a rise in AK cases and skin cancer in the following years, primarily due to climate change and the increased intensity of UV radiation. With these concerning forecasts, bringing awareness to patients and focusing on treatment options is essential.

Scoring Systems for AK Assessment

As a cutaneous condition, AK has various visual assessment methods. The Actinic Keratosis Area and Severity Index (AKASI) is a digital medical device used by health professionals to score the visual assessment of the individual’s AK severity on their head (5). By dividing the head into four regions (scalp, forehead, right and left face), the percentage of the affected area can be calculated and divided into four subscores or a total AKASI score. Health professionals use the GPA (global physician assessment) to evaluate the clinical response and disease activity (6). It’s based on a 5- or 6-point scoring system to describe disease severity. Another visual AK assessment is the total lesion count (TLC), in which the quantity of AK lesions is documented.

These three assessment methods are visual and based on the subjective rating of the medical professional. Although the medical professional’s experience is irreplaceable, patients can benefit from digital monitoring and standardization for their treatment and disease progression.

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Objective monitoring: Calibrated image (left) and pseudo-colored signal-mapped images enable objective disease monitoring and quantitative analysis/measurement of skin changes independent of skin type.

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Prevention and Current Treatment Options

Avoiding direct sun exposure and using sunscreen is the easiest way to prevent AK (2). Regular skin examinations, at least annually, are essential to monitoring progression and treatment success. Besides invasive removals, such as cryotherapy, laser, or curettage (surgical removal of damaged tissue), topical treatments are also commonly used. These include cytostatic drugs (fluorouracil, ingenol mebutate) or immune response modifiers (imiquimod). The newer substance Tirbanibulin, a microtubule inhibitor (7), has been on the European market and approved for AK since July 2021. It shows 72% and 49% partial or complete cure rates, respectively. This emphasizes the importance and success of compliant treatment applications to reduce a patient’s risk of developing skin cancer.

Digital Standardized Assessment With Scarletred®Vision

As the exposure and intensity of UV radiation have been increasing due to climate change, more cases of AK and probably skin cancer will arise. As AK presents as a possible precancerous lesion, digital monitoring can help to observe possible progression or regression of the lesion itself, in addition to treatment success, especially of topical treatments. SCARLETRED has introduced software to standardize and objectively assess skin changes. By placing the skin patch next to the affected areas, health professionals and patients at home can take a picture of the lesions. The images are uploaded to the CE Class 1m Medical Device software Scarletred®Vision to be analyzed to show, e.g., pigmentation, texture, and the standardized erythema value (SEV). With the help of the software, disease progression can be monitored even remotely, and treatment can be evaluated and, if necessary, adjusted. Scarletred®Vision can support patients and the medical community by providing a high-quality assessment of the patient’s disease development. By providing objective and standardized visual results, remote usage, and questionnaires for patients as Electronic Patient Reported Outcome (ePRO), compliance can be increased, and treatment can be adjusted accordingly.

Read more about skin cancer and its standardized assessment through digital technology in our previously published article.

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