Actinic keratosis was first described by Dubreuilh in 1904. The factors implicated in development of actinic keratoses are UV rays, fair skin, blue eyes, blond hair, immmunosuppression and genetic diseases like albinism and xeroderma pigmentosum.[3
] Prevalence of actinic keratosis depends upon the skin type and geographical location. Males develop actinic keratosis more frequently than females.[1
] It develops on areas such as the face, ears and dorsa of the hands with chronic sun exposure. The rate of development of squamous cell carcinoma from actinic keratosis is estimated to be 0.025 to 16% per year.[3
] Among patients with multiple actinic keratoses, the cumulative lifetime risk of having at least one invasive squamous cell carcinoma is substantial, possibly 6-10%.[4
] The cumulative risk depends on the number of lesions and the length of time they persist.[5
] According to Foote et al
] patients with actinic keratoses at highest risk for squamous cell carcinoma are older, male, red haired and have prolonged residence as an adult in a sunny region. Induration, erythema or erosion of actinic keratoses may be indicative of progression to squamous cell carcinoma. It is believed that several years can elapse before this transformation occurs.
The lesions in actinic keratoses can be flat or raised, single or multiple, pigmented or pale and usually less than 1 cm in diameter. Microscopically, actinic keratosis is defined as epidermis having irregular hyperplasia or atrophy with keratinocytes having a disorderly arrangement, accompanied by atypia.[6
] Our case was a 35 year old male with oculocutaneous albinism. He developed lesions of actinic keratosis at the age of 15 years, which is uncommon. One of the lesions increased in size to attain the present size of 3×2×2 cm and was diagnosed as squamous cell carcinoma.
There are different treatment options for actinic keratosis; of which curettage and cryotherapy with liquid nitrogen, 5-flourouracil are commonly used options.[1
] Topical chemotherapeutic agents such as those containing 5-flourouracil are used in patients with multiple lesions,[5
] which was also the treatment offered in this case with excision of larger lesions.
Albinism is a disorder that affects individuals and their families, socially and psychologically. Children with albinism have to deal with issues such as photophobia, decreased visual acuity, extreme sun sensitivity, hearing problems and skin cancer. They also face social discrimination as a result of their appearance.[2
Children with albinism need protection from sun that can be achieved with the use of sunscreens, protective clothing, and indoor activities.[1
] They may be clearly well aware of the short-term consequences of sun exposure but may be less informed about the long-term risks of developing skin cancer. The children themselves must be convinced that staying out of the sun is a sensible and worthwhile choice. The involvement of the parents is also crucial to a sustained health intervention plan, if mothers can be educated and informed about albinism they will have more confidence to deal with their child's condition.[7
] The Regional Dermatological Training Center (RDTC) in Moshi, Tanzania runs a mobile skin care clinic where a doctor and a nurse regularly visit villages to examine the skin of albinos and provide education on protection from UV light exposure.[8
] It is very important for children with albinism to be accepted socially so that they can lead a normal life.