Cutaneous Precancers: Current Concepts in Etiology, Pathogenesis, Diagnosis, and Management

Cutaneous precancerous lesions represent a heterogeneous group of pathological conditions associated with an increased risk of progression to non-melanoma skin cancers, most commonly cutaneous squamous cell carcinoma (cSCC). They reflect a dynamic process of skin carcinogenesis, characterized by a biological continuum ranging from actinic keratosis (AK) through squamous cell carcinoma in situ to invasive carcinoma. This review summarizes the key clinical features, etiological factors, diagnostic approaches, and current therapeutic strategies for cutaneous precancerous lesions. Chronic ultraviolet (UV) exposure plays a central etiological role, along with genetic predisposition, viral infections, and states of immunosuppression. Actinic keratosis is the most common form and represents an early clinical manifestation within the spectrum of squamous cell carcinogenesis. Diagnosis is primarily based on clinical and dermoscopic evaluation, with histopathological confirmation recommended for suspicious or atypical lesions; however, diagnostic accuracy may be limited by interobserver variability and the absence of reliable biomarkers for predicting lesion progression. Contemporary therapeutic approaches include both lesion-directed and field-directed strategies, reflecting the concept of field cancerization, although the lack of standardized treatment algorithms and limited comparative evidence from large-scale studies remain important challenges. Treatment modalities encompass cryotherapy, topical pharmacological agents, photodynamic therapy, laser ablation, and surgical excision, yet recurrence rates and long-term outcomes vary considerably across modalities. Early diagnosis, individualized treatment, and effective photoprotection are essential for reducing the risk of progression to invasive carcinoma and decreasing the overall burden of non-melanoma skin cancers. Future research should focus on improving risk stratification through the identification of molecular and imaging biomarkers, advancing non-invasive diagnostic technologies, and conducting well-designed prospective trials to establish evidence-based treatment strategies. Additionally, the development of targeted and immunomodulatory therapies, along with strengthened preventive measures, may further optimize patient outcomes.