85% of Survey Respondents Do Not Know What Actinic Keratosis Is

Image courtesy of DermNet

Earlier this year, Almirall conducted a study¹ in the US and Europe and found that 85% of respondents were “unaware of the existence of actinic keratosis (AK).” AK is a chronic skin condition that typically develops on the most sun-exposed areas of the body and is generally considered early warning signs of squamous cell carcinoma (SCC).

Almirall’s study included over 2500 participants over the age of 35 and was designed to better understand the level of knowledge about AK and skin habits among populations in Spain, Germany, Italy, the UK, and the US.

According to the survey, 57.73% of respondents have never had their skin checked by a professional, and almost one-third of respondents do not perform self-exams to look for suspicious marks or lesions.

To further discuss the significance of these findings and stress the importance of AK awareness, Dermatology Times spoke with Girish Gupta, MB ChB, FRCP, dermatologist and skin cancer expert at the Nuffield Health Edinburgh Clinic in Edinburgh, Scotland.

Dermatology Times: Can you please provide an overview of the data from the AK awareness survey?

Girish Gupta, MB ChB, FRCP

Gupta: Almirall's survey was an interesting overview of actinic keratosis (AK) knowledge, as 500 subjects from the UK, Germany, Spain, Italy, and the US were asked about this subject. The survey revealed that 85% of the respondents did not know what AK is¹, which does not surprise me.

Actinic keratosis is a very common condition, with an estimated prevalence of 13.3% in the European population.² In my clinic, I see a lot of people with AK, especially the elderly, and most of them think this is due to simple aging. Most people therefore do not go to see their doctor about it. In fact, when they do go, it is usually for another skin or medical problem and AK lesions are found on examination. I think it is important to be aware of AK because, first of all, 40 to 80% of squamous cell carcinomas develop from AKs³, but there are also studies showing that patients with AK can concurrently have other skin cancers like basal cell carcinoma, squamous cell carcinoma, and melanoma. It is not just about treating the patient with AK, but about treating the patient holistically.

Dermatology Times: How should dermatology providers use the information from the survey to better diagnose and treat AK?

Gupta: There are differences between countries. There are some where direct access to dermatologists is easier, such as Germany and Spain, but it is more difficult to access dermatologists directly in the UK, simply because most patients have to go through their general practitioners (GPs) first and then referred to us. Only a small proportion of patients with AK will therefore be referred to UK dermatologists.

Many of these patients will be managed in primary care or in the community. I think the advice in the UK should be that patients should be able to recognize AK and be aware of the potential skin cancer risk.

If they require treatment, then this should be initiated in primary care in the first instance and those patients who are in the higher risk group should be referred to dermatology services, partly because we do not have the capacity to treat everyone with AK. I think that this is one of the differences between us and our European colleagues.

Dermatology Times: What are some of the major challenges in treating AK?

Gupta: The first challenge in managing AK is making an accurate diagnosis. Many patients do not know what AK is and I think this condition is underestimated and underdiagnosed. The second challenge is advising on appropriate treatment. The third challenge for patients who have significant actinic damage, and perhaps skin cancers, is to get them referred to secondary care in a timely fashion. Patients have a lot of treatment options and should be advised on the best, evidence-based therapy depending on their AK presentation.

Dermatology Times: What should fellow dermatology providers know about AK treatment and management, as well as Almirall’s commitment to increasing awareness?

Gupta: In terms of knowledge, the UK dermatology community is well-versed in AK and how to deal with them. The main problem is diagnosis and appropriate management in primary care and in the community. Patients may be reviewed by nurses or pharmacists, as well as their GPs. Some healthcare professionals may be unfamiliar with this condition and the risks this can pose to the patient. I think the main focus should be on improving education in the primary care community.

I believe that awareness campaigns that support the diagnosis of AK in the community, such as the one undertaken by Almirall, are important. Patients need to know that they have a skin issue related to chronic sun damage, and that this issue goes beyond AKs, as some of them are likely to have skin cancers which have not been picked up. It is also good for patients to know that they have a condition that they can manage and hopefully prevent further progression through appropriate therapy.

References

1. 85% of people unaware of actinic keratosis, the most common pre-cancerous skin condition. Almirall. News release. May 23, 2023. Accessed September 27, 2023. https://www.almirall.com/newsroom/news/85-of-people-unaware-of-actinic-keratosis-the-most-common-pre-cancerous-skin-condition
2. Palmisano G, et. al. Prevalence and determinants of actinic keratosis in Europe based on the Euromelanoma campaign. Presented at the 19th EADO Congress, 20-22 April: 2023.
3. Stockfleth E, Peris K, Guillen C, et al. Physician perceptions and experience of current treatment in actinic keratosis. J Eur Acad Dermatol Venereol. 2015;29(2):298-306. doi:10.1111/jdv.12530