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April 1992

Malignant Transformation From Actinic Keratoses to Squamous Cell Carcinomas

Author Affiliations

Department of Dermatology; Departments of Dermatology, Otolaryngology, and Surgery (Plastic Surgery) University of Michigan 1910-0314 Taubman Center Ann Arbor, MI 48109

Arch Dermatol. 1992;128(4):560-561. doi:10.1001/archderm.1992.01680140144022

To the Editor.—  Two recent articles addressed some of the arguments for and against treating actinic keratoses (AKs).1,2 Although Dodson et al1 presented a patient-oriented perspective (the risk of malignant conversion over 10 years), and Marks2 presented his practical and economic perspective, it is surprising that neither article addressed the most important justification for the treatment of AKs—ie, the AK is much more likely to convert into a squamous cell carcinoma (SCC) than the surrounding skin. The ability to identify high-risk individuals is of obvious importance in any screening program. The ability to identify high-risk areas of human tissue is exceptionally useful and unusual in medicine. We present our perspective on the relative risk of malignant transformation (to SCCs) in AKs compared with normal skin.Current concepts regarding malignant transformation of AKs to SCCs are largely based on work of Marks et al.3 They conducted a

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