Abstract
Purpose :
Actinic Keratosis (AK) is an ultraviolet (UV)-related precancerous lesion, particularly UV-A radiation exposure leading to a mutated p53 gene that may result in a malignant transformation (carcinoma). Histopathologically it presents with acanthosis of the epithelium/epidermis, accompanied by extensive areas of actinic damage. In all cases, the finding of atypia of the epithelial cells is very important for the final diagnosis. There are few reports of case series providing clinical and pathological details to aid in the clinical assessment of periocular region, in particular eyelid and conjunctiva. This study aims to assess the epidemiological, clinical, and histopathological features of AK of these ocular regions to allow early diagnosis and treatment.
Methods :
The MUHC-McGill University Ocular Pathology & Translational Research Laboratory studied 207 patients and 215 biopsied lesions with a final pathological diagnosis of AK amidst 1993 and 2023. Following the exclusion criteria of insufficient clinical information, 16 patients and 17 lesions were excluded, therefore 191 patients and 198 lesions were analyzed. Exclusion criteria included the absence of data on the lesion’s location or laterality plus lesions sited elsewhere then the eyelid or conjunctiva.
Results :
The mean age of diagnosis for eyelid AK (EAK) was 73 years old (range:26–97), with 85.6% of EAK occurring in the 61–100 year old age group. The mean age for conjunctival AK (CAK) was 63 years old (range:31-84). Among all AK patients, a male predominance was observed. The overall malignant transformation (MT) rate was 18.6% (n=34/183) for EAK and 26.7% (n=4/15) for CAK. Among EAK lesions, 53% were typical AKs , 43.2% (n=79/183) were hypertrophic histopathological variants and 3.8% (n=7/183) were atrophic.. Comparatively, out of all CAK lesions,73.3% (n=11/15) were typical AKs, 26.7% (n=4/15)_were hypertrophic and none were atrophic.. The most common lesion site in the eyelid was the lower eyelid, constituting for 52.2% (n=85/163).
Conclusions :
To the best of our knowledge, this is largest series of patients with EAK and CAK. This study emphasizes the importance of early excision with safety margins as a primary choice of treatment due to the premalignant nature of AK. The risk of MT does exist in both EAK and CAK. Therefore, proper prevention methods, early diagnosis, treatment, and follow-up are crucial for these particular patients.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.