BACKGROUND: In accordance with the increase of the old age group, the incidence of actinic keratosis (AK) also increases. But there has been no comparative study between the clinical and histopathological margins. OBJECTIVE: The purpose of this study was to compare the clinical margin with histopathological margin of AK in Korean patients. METHOD: All cases of AK confirmed by biopsy from February 1, 1993 to May 31, 2003 were reviewed by hospital records and biopsy slides. Total 50 AK cases excised with 2mm surgical free margin were selected and analyzed clinically and histopathologically. RESULTS: 1. Histopathologically, hypertrophic type of AK was noted in 18 cases (36%), atrophic type in 8 cases (16%), bowenoid type in 5 cases (10%), acantholytic type in 3 cases (6%), pigmented type in 2 cases (4%), and combined form of hypertrophic and atrophic types was noted in 7 cases (14%), combined form of atrophic and pigmented types in 5 cases (10%), and combined form of acantholytic and pigmented types in 2 cases (4%). 2. The total proportion of surgical margin involvement was 44% (22/50): hypertrophic type in 55.5% (10/18), atrophic type in 87.5% (7/8), bowenoid type in 20% (1/5), acantholytic type in 33.3% (1/3), pigmented type in 0% (0/2), combined form of hypertrophic and atrophic types in 28.5% (2/7), combined form of atrophic and pigmented types in 20% (1/5), and combined form of acantholytic and pigmented types in 0% (0/2). CONCLUSION: In 50 cases of AK excised with 2mm surgical free margin, 22 cases (44%) showed tumor cells on the surgical margin. Especially hypertrophic and atrophic types showed significant proportion of marginal involvement. In respect that hypertrophic and atrophic types are more common than other subtypes of AK in Korean patients, skin biopsy and check-up for surgical margin are recommended in all AK.
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