The ‘5R + R’ Rule: A simple and comprehensive method for diagnosis of actinic keratosis

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The ‘5R + R’ Rule: A simple and comprehensive method for diagnosis of actinic keratosis

Journal Title: Sultan Qaboos University Medical Journal - Year 2019, Vol 19, Issue 1

Abstract

Dear Editor, Actinic keratoses (AKs) or ‘solar keratoses’ are cutaneous lesions that arise on areas of the skin that are chronically exposed to ultraviolet (UV) radiation [Figure 1]. AKs are considered early manifestations of non-melanoma skin cancer as they can progress to squamous cell carcinoma (SCC) which can be invasive and life-threatening. Te estimated rate of malignant conversion to SCC ranges from 0.025–20% per year and increases with the number of lesions.1 AK is a prevalent disease and a major public health problem due to its growing incidence and its potential for malignant transformation.2 Despite this, low awareness of the risk of malignant transformation and lack of standardised methods of diagnosis are the main challenges in AK management.3 To address this unmet need, the authors of this letter have developed a simple, yet comprehensive method of diagnosis. Te reddish, rough, recurrent, cephalic region, radiation + risk (5R + R) rule is an easy-to-remember method that can be used in both primary and secondary care settings for routine clinical examinations. Tis formula is important during the physical examination as it can help physicians with regard to diﬀerentiating lesions that have a similar appearance. Tis mnemonic includes ‘Rs’ that refer to easily identifable predictive factors of AK [Table 1]. Te frst ‘R’ is for ‘reddish’ and highlights the need to examine visible characteristics of AK lesions. AKs typically present as erythematous macules, papules or plaques ranging from skin-coloured to reddish-brown.1 Te second ‘R’ stands for ‘rough’ and stresses the need to explore the texture of the lesions. AK lesions are often easily recognised by palpation, presenting a rough surface with a sandpaper-like structure. Both colour and thickness of lesions are among the main distinctive features of AK that correlate with clinical grading.1 Te third ‘R’ is for ‘cephalic region’ which focuses on the location of AK lesions that tend to develop on the cephalic region that is constantly exposed to UV radiation such as the head and neck.1 Te fourth ‘R’ is for ‘UV radiation’, which is the main risk factor for AK development due to its DNA-damaging potential.1 Chronic exposure to UV radiation leads to the accumulation of mutations that can ultimately result in malignant transformation. Tus, lifetime sun exposure, sunburns and other related risk factors should be recorded during the initial evaluation of the patient. Likewise, caregivers should check periodically all the exposed areas of the skin for signs of sun damage such as telangiectasia, wrinkles, dryness, dyschromia and elastosis.4 Te ffth ‘R’ is for ‘recurrent' because with sun exposure, it is common to fnd recurrent lesions with a complicated management. New lesions tend to appear frequently in the same sun exposed areas even after proper treatment. Tis item reinforces the need to follow-up patients periodically to detect recurrent lesions.

Authors and Affiliations

Javier Dominguez-Cruz, Ricardo Ruiz-Villaverde

Keywords

The ‘5R + R’ Rule

EP ID EP43107
DOI http://dx.doi.org/10.18295/squmj.2019.19.01.017
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