Talk:Actinic keratosis

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WikiProject Medicine / Dermatology / Pathology (Rated C-class, High-importance)
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Treatment[edit]

I have been advised by my doctor to use Solaraze

Stuart Ward UK (talk) 21:06, 21 June 2014 (UTC)

infection/spread[edit]

I think AK is not supposed to be infectious, or even self-infectious. The article should say so, one way or the other. But there still needs to be an explanation for why AKs would be clustered, for example on the forehead, yet absent from the ears, which should have had similar sun exposure? And the article needs photos, esp of what treatment with Imiquimod (Aldara) looks like! 69.87.194.177 20:01, 13 June 2006 (UTC)

I am guessing that AK is not infectious, that only if it turns into SCC can it then potentially metastasize. But it does seem like each individual area of AK traces back to just a single cell that mutates and then spreads in that area. -69.87.193.168 02:07, 6 March 2007 (UTC)

simplistic[edit]

This article is much too superficial and simplistic. No detailed discussion of the mutations involved. No details about the layers of skin involved, or cross-section diagrams, or clear links to such. We need this kind of material and more, but in words we can understand: "In both histologic and molecular parameters, AKs share features with squamous cell carcinoma. AK is an epidermal lesion characterized by aggregates of atypical, pleomorphic keratinocytes at the basal layer that may extend upwards to involve the granular and cornified layers. The epidermis itself shows an abnormal architecture, with acanthosis, parakeratosis, and dyskeratoses. Cellular atypia is present, and the keratinocytes vary in size and shape. Mitotic figures are present." -69.87.193.168 02:07, 6 March 2007 (UTC)

Incidence??[edit]

The statistics in the Incidence section make no sense. If half the population has A.K., then one small group could not possibly have 250 times the incidence. And then it says that this definitively "leads to cancer", whereas elsewhere it says 20% chance. Doc Adams (talk) 00:21, 21 January 2011 (UTC)

The comment about how prevalent the condition is requires a reference. Thimotei (talk) 22:24, 3 September 2013 (UTC)

Cost per spritz, CPT code 17000[edit]

  • www.bozemanskinclinic.com/skin-conditions/actinickeratoses.php
"Chemical face peels, mini dermabrasion, and superficial laser will temporarily seem to make keratoses go away. But they grow back in a few weeks to months. The reason for this is that the precancerous cells come from a reservoir in the basal layer. Peeling agents do not get that deep. If they do, they cause unacceptable scars. Liquid nitrogen tends not to damage the basement membrane."
  • emedicine.medscape.com/article/1125851-overview
"After the development of the vacuum flask to store subzero liquid elements, such as nitrogen, oxygen, and hydrogen, the use of cryotherapy dramatically increased. By the 1940s, liquid nitrogen became more readily available, and the most common method of application was by means of a cotton applicator. In 1961, Cooper and Lee introduced a closed-system apparatus to spray liquid nitrogen. In the late 1960s, metal probes became available. By 1990, 87% of dermatologists used cryotherapy in their practice."
  • www.princetoncryo.com/cryosurgery-and-dermatology.html
"Liquid nitrogen cryosurgery with a cryogun is the coldest (-196º C), most effective, and most versatile cryosurgical technique available. Using liquid nitrogen equipment like a cryogun is much colder and therefore more effective than applying LN2 with a swab (-20º C), nitrous oxide (-75º C), and disposable cold sprays (-55º C to -70º C). Also, Brymill has a MUCH lower cost to use on an ongoing basis than disposable cold sprays because it is not necessary to repeatedly buy $150-$200 disposable cans, each of which only can treat approximately 25-65 lesions."
  • www.ncbi.nlm.nih.gov/pubmed/21738958
"Cryopeeling for treatment of photodamage and actinic keratosis: liquid nitrogen versus portable system.
The aim of this study was to compare two cryopeeling methods (liquid nitrogen- LN and portable system - PS) and demonstrate their efficiency in the treatment of actinic keratoses, patient tolerance, researcher and patient preference and aesthetic results.
In the treatment of actinic keratoses, LN obtained 74% efficiency and PS, 62% (p = 0.019).... Treatment with LN obtained some degree of improvement in 62.5% of the cases, while treatment with PS obtained some degree of improvement in 52% of the cases (p> 0.05). Discussion: Treatment with the PS showed better tolerance, but was less efficient than LN..."

Although liquid nitrogen is the proper traditional method of skin lesion cryosurgery, other similar technologies are now common. The generic term for this alternative approach seems to be PORTABLE. The typical cost seems to be about US $5 per lesion treated, for the freezing materials:

  • www.docsavings.com/mm5/merchant.mvc?Screen=CTGY&Store_Code=D&Category_Code=Cry&gclid=CJDpxeeb_bUCFVKf4AodOxQAwA
"Verruca-Freeze is a simple, safe, and effective alternative to liquid nitrogen. It is cleared to treat 21 benign skin lesions including common warts, plantar warts, genital warts, skin tags, age spots, and many more!"
SMC35 Verrucafreeze Mini Replacement Canister: 30-35 freezes, $185.00
VFC65 Verrucafreeze Replacement Canister: 60-70 freezes, $260.00
VFL Verrucafreeze 236ml Canister (100 freezes), $305.00
  • www.portlanddermclinic.com/billing-faqs.html
"Q Freezing of Actinic Keratosis: The doctor sprayed me for half a second - why is it so expensive?"
"A The treatment of Actinic Keratosis involves spraying liquid nitrogen on the lesions. The cost starts at $145 and increases according to the number of lesions treated. Our fees are in line with other dermatologists in our area who provide the same service."
  • ICD-9-CM Code: 702.0 Actinic keratosis
"The correct code is found in the ICD-9-CM index under the main term “keratosis” and the subterm “actinic” which references code 702.0."
Diagnosis: ICD-9 code 702.0 (Other dermatoses; actinic keratosis) describes AK.
  • www.ama-assn.org/resources/doc/rbrvs/2012-rbrvs-congress-patch.pdf 2012 Relative Value Units
17000 Destruct premalg lesion  2.38rvus $81.01
17003 Destruct premalg les 2-14 0.21rvus $7.15
17004 Destroy premal lesions 15/> 5.05rvus $171.89

The standard Medicare insurance cost is about $81 to treat the first skin lesion, CPT code 17000; $7 per additional lesion, CPT code 17003; $172 bulk cost for 15 or more lesions, CPT code 17004.-96.233.19.238 (talk) 14:36, 15 March 2013 (UTC)

Images[edit]

The image at the top of this page is not a good example of actinic keratosis, and in my view pretty atypical. I'm adding this here because I will be looking around for a better image, but if someone else finds it first please feel free to add it. -- CFCF (talk · contribs · email) 09:31, 2 July 2014 (UTC)