光化性角化病 (AK) 是常见的癌前皮肤病变，进展为皮肤鳞状细胞癌 (SCC) 的风险较小。有一些证据表明，除了鳞状细胞癌之外，AK 患者患其他皮肤癌的风险也会增加。然而，AK 患者患皮肤癌的绝对风险尚不清楚。为了计算 AK 医疗保险受益人未来患皮肤癌的绝对和相对风险。这项回顾性队列研究是使用 4999999 名未识别的随机样本进行的2009 年至 2018 年在职医疗保险受益人。接受治疗的 AK 患者被纳入其中，脂溢性角化病 (SK) 患者被纳入作为比较组。所有患者都需要在数据集输入和首次 AK 或 SK 之间有至少 1 年的时间。有皮肤癌病史的患者被排除在外。分析了 2022 年 9 月至 2023 年 3 月的数据。结果首先是手术治疗的皮肤癌，包括角质形成细胞癌（包括鳞状细胞癌和基底细胞癌 [BCC]）和黑色素瘤。评估了 AK 患者患皮肤癌的绝对风险。使用调整后的竞争风险回归将 AK 患者与 SK 患者的皮肤癌风险进行比较。共有 555945 名 AK 患者（平均 [SD] 年龄，74.0 [7.4] 岁；55.4% 女性）和 481024 名 SK 患者（平均 [SD] 年龄为 73.3 [7.3] 岁；72.4% 为女性）。首次 AK 后 1 年患皮肤癌的绝对风险为 6.3%（95% CI，6.3%-6.4%），3 年为 18.4%（95% CI，18.3%-18.5%），3 年为 28.5%（95 5 年时% CI，28.4%-28.7%）。与 SK 患者相比，AK 患者患皮肤癌的风险增加（任何皮肤癌：调整后风险比 [aHR]，2.17；95% CI，2.15-2.19；角化细胞癌：aHR，2.20；95% CI，2.18-2.22 ；SCC：aHR，2.63；95% CI，2.59-2.66；BCC：aHR，1.85；95% CI，1.82-1.87；黑色素瘤：aHR，1.67；95% CI，1.60-1.73）。患有 AK 的老年患者患皮肤癌的绝对风险很高，相对风险也较高。 AK 可能是紫外线暴露和皮肤癌风险增加的临床标志物，包括鳞状细胞癌、基底细胞癌和黑色素瘤。然而，缺乏针对 AK 患者皮肤癌后续监测的指南。为 AK 患者的皮肤癌监测制定基于证据的建议至关重要。

Actinic keratoses (AK) are common premalignant skin lesions with a small risk of progressing to cutaneous squamous cell carcinoma (SCC). There is some evidence that patients with AKs also have increased risks of other skin cancers beyond SCC. However, the absolute risks of skin cancer in patients with AKs are unknown.To calculate the absolute and relative risks of future skin cancer in Medicare beneficiaries with AKs.This retrospective cohort study was performed using a deidentified, random sample of 4 999 999 fee-for-service Medicare beneficiaries from 2009 through 2018. Patients with treated AKs were included, and patients with seborrheic keratoses (SKs) were included as a comparator group. All patients were required to have at least 1 year between data set entry and first AK or SK. Patients with a history of skin cancer were excluded. Data were analyzed from September 2022 to March 2023.Outcomes were first surgically treated skin cancer, including keratinocyte carcinoma (including SCC and basal cell carcinoma [BCC]) and melanoma. The absolute risks of skin cancer in patients with AKs were evaluated. Skin cancer risks in patients with AKs were compared with patients with SKs using adjusted competing risks regression.A total of 555 945 patients with AKs (mean [SD] age, 74.0 [7.4] years; 55.4% female) and 481 024 patients with SKs (mean [SD] age, 73.3 [7.3] years; 72.4% female) were included. The absolute risk of skin cancer after a first AK was 6.3% (95% CI, 6.3%-6.4%) at 1 year, 18.4% (95% CI, 18.3%-18.5%) at 3 years, and 28.5% (95% CI, 28.4%-28.7%) at 5 years. Patients with AKs had increased risk of skin cancer compared with patients with SKs (any skin cancer: adjusted hazard ratio [aHR], 2.17; 95% CI, 2.15-2.19; keratinocyte carcinoma: aHR, 2.20; 95% CI, 2.18-2.22; SCC: aHR, 2.63; 95% CI, 2.59-2.66; BCC: aHR, 1.85; 95% CI, 1.82-1.87; and melanoma: aHR, 1.67; 95% CI, 1.60-1.73).In this cohort study, older patients with AKs had substantial absolute risks, as well as elevated relative risks, of skin cancer. AKs may be clinical markers of UV exposure and increased skin cancer risk, including SCC, BCC, and melanoma. However, guidelines are lacking for follow-up skin cancer surveillance in patients with AKs. Efforts to develop evidence-based recommendations for skin cancer surveillance in patients with AKs are paramount.