Keratoelastoidosis marginalis as a marker of cumulative actinic damage: A scientific letter

Abstract

Background: Keratoelastoidosis marginalis (KEM) is a rare, acquired marginal keratoderma typically affecting older individuals with long-term sun exposure and manual labour. Although regarded as benign, its broader clinical relevance is often overlooked.
Methods: We report a single case of histologically confirmed KEM identified during routine skin cancer surveillance in a high-risk patient. Clinical findings were correlated with histopathology and associated cutaneous diagnoses.
Results: A 65-year-old fair-skinned male farmer with extensive occupational sun exposure presented with characteristic linear keratotic plaques along the margins of both hands. Histology demonstrated prominent solar elastosis with degenerated collagen and elastic fibres, consistent with KEM. During the same consultation, the patient was diagnosed with a synchronous basal cell carcinoma. No malignant transformation was identified within the KEM lesions themselves.
Conclusion: This case highlights KEM as a visible marker of cumulative actinic damage rather than an isolated keratoderma.
Contribution: Recognition of KEM in primary care and dermatology settings may assist clinicians in identifying patients at increased risk of keratinocyte skin cancer and prompt comprehensive skin examination, preventive counselling and appropriate surveillance.