A novel actinic keratosis field assessment scale for grading actinic keratosis disease severity

Brigitte Dréno, Rino Cerio, Thomas Dirschka, Ignasi Figueras Nart, John T. Lear, Ketty Peris, Andrés Ruiz De Casas, Shaniko Kaleci, Giovanni Pellacani

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17 Citations (Scopus)


Actinic keratosis (AK) lesions are surrounded by field cancerization (areas of subclinical, non-visible sun da-mage). Existing AK grading tools rely on AK counts, which are not reproducible. An Actinic Keratosis Field Assessment Scale (AK-FAS) for grading the severity of AK/field was developed. Standardized photographs of patients representing the full range of AK severity were collected. Six investigators independently rated each photograph according to 3 criteria: AK area (total skin area affected by AK lesions), hyperkeratosis and sun damage. Inter-rater reproducibility was good for all 3 criteria. Validation of the AK-FAS showed good reproducibility for AK area and hyperkeratosis, even for dermatologists untrained on use of the scale. In conclusion, the AK-FAS is objective, easy to use and implement, and reproducible. It incorporates assessment of the entire field affected by AK instead of relying on lesion counts. Use of the AK-FAS may standardize AK diagnosis, making it relevant to routine clinical practice.
Original languageEnglish
Pages (from-to)1108-1113
Number of pages6
JournalActa Dermato-Venereologica
Publication statusPublished - 2017


  • 2708
  • Actinic keratosis
  • Face
  • Field cancerization
  • Grading scale
  • Humans
  • Keratosis
  • Keratosis, Actinic
  • Photography
  • Reproducibility of Results
  • Scalp
  • Severity of Illness Index
  • Sunlight


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