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Actinic Keratosis
Checked: 23-08-2020 by
Vicky Ryan Next Review: 23-08-2021
Principles of Management
Given the very large numbers of patients who have AK it is important that the majority should be managed in the community, and preferably by GPs otherwise consultant and GPwSI clinics will become overburdened, and patients with more serious skin problems will wait longer to be seen by a specialist. This approach is supported by local clinicians.
Local clinicians recommend following clinical guidelines by the Primary Care Dermatology Society (PCDS): Actinic keratosis clinical guidance
Referral Guidance
Uncomplicated actinic keratoses can normally be diagnosed and managed in primary care.
If advice or confirmation of diagnosis is required then consider using Dermatology Advice and Guidance initially.
Referrals can also be made to the Community Dermatology Service (now available to all BNSSG practices) who can offer individual patient management plans and advice.
Referral to secondary care for assessment and treatment of actinic keratosis is subject to the Benign Skin Lesions Policy and may be returned unless funding is in place.
Red Flags
The following features could suggest transformation from an AK into an SCC:
If a lesion is suspicious of an SCC, please refer via the Skin 2WW pathway.
Other criteria for referral to a Dermatologist :-
Patients with actinic damage who are at much higher risk of developing an SCC:
- Immunosuppressed patients, in particular those post-transplant.
- Very young patients presenting with Actinic keratosis – consider xeroderma pigmentosum.
Resources
Information for Health Care Professionals:
https://www.bad.org.uk/guidelines-and-standards/clinical-guidelines/ and PIL: https://www.bad.org.uk/pils/actinic-keratoses/
Actinic keratosis clinical guidance PCDS
Information on Actinic Keratosis:
dermnetnz.org/topics/actinic-keratosis/
Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.
Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.
