Actinic keratosis (AK) is a very common skin disease caused by chronic sun exposure. AKs have historically been characterized as being "precancerous" or "premalignant." It is true that these lesions do not possess metastatic potential, because they are confined to the epidermis, but it is not accurate to deem them "premalignant." AK qualifies as a malignant neoplasm, because it also fulfills criteria for malignancy in classic pathology, namely, the capability, or potential, to kill by either destruction of tissue locally or by metastasis widely. In this context, AK is considered now by many a carcinoma in situ and can persist or progress to invasive squamous cell carcinoma (iSCC), which rarely metastasizes. Through this controversy, which speaks to an issue we have been debating for at least a century, we should like to start a constructive debate to reach a unanimous conclusion considering the various theories and points of view in the literature.

Topical sunscreens are the mainstay for protection from ultraviolet (UV) radiation. With skin cancer rates on the rise and great interest in reversing or preventing the effects of photoaging, new molecules with potential to defend against UV damage have received a great deal of attention. Specifically, there is a growing interest in herbal substances that offer protection against the damaging effects of UV rays. Herbal substances may work as adsorbents of the UV rays and antioxidants and potentially have few side effects. Many of them have shown the potential to protect from UV rays in in vitro studies and animal models; however, only a limited number of human studies were conducted which we discuss in the current review. Among the most studied herbal substances that have proven photoprotective activity are green tea extract, carotenoids, and Polypodium leucotomos extract (PLE). They have been shown to increase minimal erythema dose and improve signs of photodamage. PLE has been shown to be helpful in holistic treatment of several conditions, including polymorphous light eruption, solar urticaria, and melasma; it also may be used as an adjuvant to the UVB treatment of vitiligo and photodynamic therapy of actinic keratosis.

5-fluorouracil, a fluoropyrimidine antineoplastic drug, is used to topically treat actinic keratoses. Local skin reactions to the medication are common and anticipated. However, severe adverse events from topical 5-fluorouracil are rare and unexpected. A 69-year-old man with a lower lip actinic keratosis developed severe neutropenia on day 11 of topical 5-fluorouracil treatment - after 14 applications. After receiving a subcutaneous injection of filgrastim, his neutrophil count normalized. The PubMed database was used to search the following terms: agranulocytosis, cream, 5-fluorouracil, granulocytopenia, neutropenia, severe, systemic, topical, and toxicity. The papers, and relevant cited references, generated were reviewed. Systemic reactions to topical 5-fluorouracil included angioedema, melanonychia, neurologic conditions (such as acute cerebellar syndrome, headaches, and peripheral neuropathy exacerbation), taste alteration, and systemic toxicity requiring hospitalization (including severe neutropenia). One of the individuals (a man with severe neutropenia and other symptoms) also had a deficiency of dihydropyrimidine dehydrogenase, the enzyme that catalyzes the rate-limiting step in 5-fluorouracil metabolism. Evaluation for dihydropyrimidine dehydrogenase deficiency is not routinely performed in patients receiving systemic or topical 5-fluorouracil. Also, the incidence of potentially severe 5-fluorouracil-induced toxicity associated with topical application of the drug may be greater than documented.

Cutaneous field cancerization arises due to UV-induced carcinogenesis of a "field" of subclinically transformed skin and actinic keratoses (AKs) with a tendency to progress and recur. Commonly used treatment methods for multiple AKs include imiquimod, fluorouracil, ingenol mebutate, and photodynamic therapy; however, new options in field-directed therapy with superior efficacy, cosmesis, and convenience may appeal to patients. Ablative and nonablative lasers may fulfill these advantages and have been investigated as monotherapies and combination therapies for field cancerization. In this article, a review of the literature on various laser modalities with a focus on efficacy is provided.

Actinic keratoses (AKs) can progress into invasive squamous cell carcinoma and thus may become a life threatening disease. Argon plasma coagulation (APC) might complement the therapeutic armamentarium in particular for AK lesions. However, there is no data on APC induced micromorphological changes following the treatment of AKs. We aimed to determine in-vivo APC induced effects on the epidermis and dermo-epidermal junction zone (DEJ) in AK lesions. We performed APC in 108 AKs using the spray mode with a power setting of 15W and a flow rate of 2.0 L/min. Before and after the intervention, optical coherence tomography (OCT) was performed. After APC, 74.2% (46/62) lesions presented with clearly demarcated DEJ and without any epidermal tissue left, 25.8% (16/62) of treated lesions showed residual epidermal tissue left. In 19.4% (12/62) parts of the DEJ and in 6.5% (4/62) the entire DEJ could not be discriminated. The Chi-squared test showed a significant (P=0.0025) association between the presence of hyperkeratosis prior to APC and intact DEJ after APC. In conclusion, APC as shown by OCT is a well controllable treatment modality for AKs causing only limited damage to dermal tissue. Further studies are needed to evaluate clinical outcome as well as recurrence rates. This article is protected by copyright. All rights reserved.

Gout tophi around auricular area are common in old men. The differential diagnosis of papules or nodules on the ear includes tophaceous gout, rheumatoid nodules, basal or squamous cell cancer, melanoma, verruca vulgaris or actinic keratosis. The presence of the skin cancer, most commonly located on the head and neck, is often related to the long exposure of the skin to sunlight. Elderly patients are the predominant group of patients with skin malignancies. The aim of this study is to emphasize the importance of early cancer detection in elderly people and use of appropriate therapeutic options that take into account the special requirements of geriatric patients. In this article the case of a 91-year-old man with advanced gout and squamous cell cancer of the skin of the ear, treated radically with a positive clinical effect, is presented. Moreover, the diagnostic and therapeutic problems are presented.