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Actinic Keratosis Diagnosis and Increased Risk of Developing Skin Cancer: A 10-year Cohort Study of 17,651 Patients in Sweden
Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Biomedical and Clinical Sciences, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Dermatology and Venerology.
Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Forskningsstrategiska enheten.
Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.ORCID iD: 0000-0001-6688-3860
2020 (English)In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 100, no 8, article id adv00128Article in journal (Refereed) Published
Abstract [en]

Actinic keratosis is the most common actinic lesion in fair-skinned populations. It is accepted as an indicator of actinic skin damage and as an occasional precursor of squamous cell carcinoma. The aim of this study was to investigate, in a cohort of patients with a diagnosis of actinic keratosis, the relative risk of developing skin cancer during a follow-up period of 10 years. This registry-based cohort study compared a cohort of 2,893 individuals in south-eastern Sweden, who were diagnosed with actinic keratosis during the period 2000 to 2004, with a matched-control cohort of 14,668 individuals without actinic keratosis during the same inclusion period. The subjects were followed for 10 years to identify skin cancer development in both cohorts. Hazard ratios with 95% confidence intervals (95% CI) were used as risk measures. Individuals in the actinic keratosis cohort had a markedly higher risk for all skin cancer forms compared with the control cohort (hazard ratio (HR) 5.1, 95% CI 4.7-5.6). The relative risk was highest for developing squamous cell carcinoma (SCC) (HR 7.7, 95% CI 6.7-8.8) and somewhat lower for basal cell carcinoma (BCC) (HR 4.4, 95% CI 4.1-5.0) and malignant melanoma (MM) (HR 2.7 (2.1-3.6). Patients with a diagnosis of actinic keratosis were found to be at increased risk of developing SCC, BCC and MM in the 10 years following diagnosis of actinic keratosis. In conclusion, a diagnosis of actinic keratosis, even in the absence of documentation of other features of chronic sun exposure, is a marker of increased risk of skin cancer, which should be addressed with individually directed preventive advice.

Place, publisher, year, edition, pages
Uppsala, Sweden: Society for the Publication of Acta Dermato - Venereologica , 2020. Vol. 100, no 8, article id adv00128
Keywords [en]
actinic keratosis, basal cell carcinoma, cohort study, melanoma, squamous cell carcinoma, skin cancer
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:liu:diva-170592DOI: 10.2340/00015555-3486ISI: 000602787000016PubMedID: 32314794Scopus ID: 2-s2.0-85084405776OAI: oai:DiVA.org:liu-170592DiVA, id: diva2:1477004
Available from: 2020-10-16 Created: 2020-10-16 Last updated: 2024-03-18Bibliographically approved
In thesis
1. Understanding Skin Cancer Risk and Prevention: with Emphasis on Actinic Keratosis Patients
Open this publication in new window or tab >>Understanding Skin Cancer Risk and Prevention: with Emphasis on Actinic Keratosis Patients
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The rising incidence of skin cancer globally makes it important to emphasize preventive measures that promote sun protection, particularly among individuals with phenotypic predisposition and/or risky sun habits. Actinic keratosis (AK) is the predominant actinic lesion observed in fair-skinned populations, recognized as a sign of actinic skin damage and as an occasional precursor to squamous cell carcinoma (SCC).   

The aim of this thesis was to explore, from a primary care perspective, how an enhanced understanding of risk factors for skin cancer development can aid in identifying individuals for patient education on prevention and early detection of skin cancer.  

Paper I suggests that personalized sun protection advice delivered in person by the GP can result in both short-term and long-lasting improvements in sun protective behaviour. Paper II demonstrated that individuals diagnosed with AK face a significantly elevated risk of developing SCC, basal cell carcinoma (BCC), or malignant melanoma (MM) in the following decade compared to sex- and age-matched controls. Paper III highlighted the fact that the presence of chronic lymphocytic leukaemia, and to a lesser degree hypertension and Parkinson's disease, independently raises the risk of skin cancer. This underscores the importance of providing tailored preventive guidance to individuals with these conditions. Paper IV showed that both age and male gender were factors found to be associated with an increased risk of developing skin cancer in AK patients while no risk increase was identified for any of the other variables studied.  

In conclusion, personalized sun protection advice from general physicians (GPs) can bring about lasting improvements in sun protective behaviour. Reinforcing this advice during medical consultations, such as nevi checks, is important to sustain this effect over a long period. This is encouraging for the accepted practice of giving sun protection advice to patients with MM, SCC and BCC. A diagnosis of AK not only indicates an increased risk of skin cancer but also serves as a readily identifiable criterion for implementing personalized preventive measures. The presence of AK substantially increases the likelihood of developing future skin cancer, even more pronouncedly when combined with specific comorbidities such as chronic lymphocytic leukaemia, hypertension, and Parkinson's disease.   

Future research should investigate how sun protection advice interacts with other behavioural counselling and evaluate its effectiveness over time. Additionally, exploring other factors influencing skin cancer risk in individuals with AK would facilitate the provision of comprehensive preventive interventions. 

Abstract [sv]

Den ökande förekomsten av hudcancer globalt gör det viktigt att betona förebyggande åtgärder som främjar solskydd, särskilt bland individer med solkänslig hudtyp och/eller riskfyllda solvanor. Aktinisk keratos är en mycket vanlig typ av hudförändring hos ljushyade personer, välkänd för att vara ett tecken på hudskada orsakad av långvarig solexponering, och som också kan utgöra ett förstadium till skivepitelcancer.  

Syftet med denna avhandling var att utforska, ur ett primärvårdsperspektiv, hur ökad förståelse för riskfaktorer för utveckling av hudcancer kan hjälpa till att identifiera individer för patientutbildning om förebyggande och tidig upptäckt av hudcancer, med särskilt fokus på just individer med aktinisk keratos.  

Artikel I föreslår att individuellt utformade solskyddsråd som ges personligen av allmänläkare kan resultera i både kortsiktiga och långvariga förbättringar av solskyddsbeteendet. Artikel II visade att individer som diagnostiserats med aktinisk keratos löper en signifikant ökad risk att utveckla någon av de tre viktigaste hudcancertyperna skivepitelcancer, basal-cellscancer eller malignt melanom, under det följande decenniet jämfört med individer i en köns- och åldersmatchad kontrollergrupp. Artikel III påvisade att förekomsten av kronisk lymfatisk leukemi, och i mindre grad högt blodtryck och Parkinsons sjukdom, självständigt ökar risken för hud-cancer. Detta understryker vikten av att ge skräddarsydd förebyggande vägledning till individer med dessa tillstånd. Artikel IV visade att både ålder och manligt kön var faktorer som visade sig vara associerade med en ökad risk att utveckla hudcancer hos patienter med aktinisk keratos, medan ingen riskökning identifierades för någon av de andra variablerna som studerades, såsom antal och storlek på förändringarna.  

Sammanfattningsvis kan personliga solskyddsråd från allmänläkare leda till bestående förbättringar av solskyddsbeteendet. Att återupprepa sådana råd i samband med läkarbesök, såsom vid kontroller av hudförändringar, är sannolikt viktigt för att bibehålla denna effekt över tid. Detta ger stöd till den vedertagna strategin att ge solskyddsråd till patienter med hudcancer. Förekomst av aktinisk keratos indikerar inte bara en ökad risk för hudcancer utan kan också ses som ett enkelt identifierbart kriterium för att utforma individanpassade solråd med avseende på framtida hudcancerrisk, då detta avsevärt ökar sannolikheten för att utveckla framtida hudcancer. Risken tycks ännu mer uttalad i kombination med andra samtidiga sjukdomar såsom kronisk lymfatisk leukemi, högt blodtryck och Parkinsons sjukdom.  

Framtida forskning bör undersöka hur solskyddsråd samverkar med annan beteenderådgivning och utvärdera dess effektivitet över tid. Att utforska andra faktorer som påverkar risken för hudcancer hos individer med AK skulle dessutom underlätta tillhandahållandet av omfattande förebyggande insatser.  

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2024. p. 54
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1891
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:liu:diva-201658 (URN)10.3384/9789180754675 (DOI)9789180754668 (ISBN)9789180754675 (ISBN)
Public defence
2024-04-19, Belladonna, building 511, Campus US, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2024-03-18 Created: 2024-03-18 Last updated: 2024-03-18Bibliographically approved

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Guorgis, GhassanAnderson, Chris D.Lyth, JohanFalk, Magnus

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