Actinic Keratoses (AKs) - Health Tips

What is an actinic keratosis?

“Keratosis” (plural keratosis) refers to a rough scaly spot. An actinic keratosis (sometimes called a solar keratosis) is a rough scaly spot caused by many years of repeated sun. These rough spots remain on the skin even if the crust or scale is picked off.

Why treat actinic keratosis?

Actinic keratoses are not skin cancers. However, they are often referred to as “pre-cancerous” because they may sometimes turn cancerous. It’s a good idea to remove them before this occurs. Since the treatment is much simpler, scars do not result from the treatment of the actinic keratosis. In fact, your skin will look much smoother after they are removed. On the other hand, if you wait too long and a skin cancer develops, a visible scar will result from its surgical removal.

Treatment

Treatment of actinic keratosis requires removal of the defective skin cells. They are usually treated by freezing the spots with liquid nitrogen. Freezing causes blistering and shedding of the sun-damaged skin. Sometimes we’re not sure whether or not the growth has progressed to a skin cancer. When there’s doubt, we cut the growth off and send it for microscopic analysis (biopsy). Healing after removal usually takes two to four weeks, depending on the size and location of the keratosis. Hands and legs heal more slowly than the face. The skin’s final appearance is usually excellent. Occasionally, the frozen spot may appear lighter than the surrounding skin.

When there are many actinic keratosis, a useful treatment is the application of 5-fluorouracil (5-FU). The medication is rubbed on the keratosis for several weeks. These medicines destroy sun-damaged skin cells. After three to five days the treated area starts to turn raw. The applications are continued until your physician determines that you have the needed results. Healing starts when the cream is stopped.

Can I prevent new actinic keratosis from developing?

The number of new spots can be decreased by limiting sun exposure. When exposure is necessary, sunscreen with high SPF (greater than 15) should be used. However, you may continue to develop pre-cancerous lesions due to the many years of sun exposure you have already had. These should be treated.

Elderly persons who totally avoid the sun and who use sunscreen may possibly become Vitamin D deficient (sunlight causes the skin to produce Vitamin D). Therefore, it is wise to drink three glasses of milk per day or to consume the recommended daily allowance of Vitamin D as a nutritional supplement.

What if I develop new spots in the future?

If you have severely sun-damaged skin, this therapy may need to be repeated as often as every 6 months in spite of sun avoidance from now on.

Future recurrences should not be self-treated with left over medication as you may be unknowingly treating skin cancers which should not be treated in this manner. Return to our office for an examination before re-starting treatment.

An actinic keratosis is considered a pre-cancerous lesion since a small percentage of these lesions over time may develop into a skin cancer, usually a squamous cell carcinoma. Due to its pre-cancerous features, your Dermatologist can treat the lesion by various methods to destroy the lesion before it becomes a skin cancer.

Early treatment of actinic keratoses (AKs) is generally simple, fast and effective in eliminating these growths, and preventing skin cancer.

There a many ways to treat AKs. The most common approach is with cryotherapy with liquid nitrogen (freezing). Essentially this a controlled, localized frost-bite injury that is very quick and effective in eliminating AKs.

Other treatments may include electrocautery and curettage (scraping with a special instrument), photodynamic treatment (applying a special chemical mixed with light activation), or various topical prescription medications that you can apply at home.

There are number of very good medications that may be used for AK treatment. These are often best used for "field" treatment of an area with many AKs, marked sun damage, or for those with a history of skin cancers.

I tell my patient it is a way to try to "wipe the blackboard clean" of the precancerous lesions we may not even see yet.

Medications presently available for the treatment of AKs include 5-Fluorouricil (5-FU), imiquimod (Aldara®, Zyclara®), and diclofenac (Solaraze®). These agents may also be used for discrete AKs, and the newest agent, ingenol mebutate (Picato®), is specifically for small, localized areas.

The most important part of prevention is good sun protection. Slip on shirt (or other sun-protective clothing), slap on a hat, and slop on the sunscreen.

I tell my patients to go out, be active and do the things they enjoy-- just don't strive to get a tan, and by all means avoid burning. REMEMBER also, that just because you have sunscreen on, it isn't a license to receive excess sun exposure--- just as wearing a seat belt doesn't mean it's okay to drive drunk or recklessly.

You can think of an AK lesion as a marker for an area of the skin that is at higher risk for turning into a skin cancer (primarily squamous cell carcinomas) than the surrounding skin.

Studies have proven that skin with actinic keratoses is at greater risk of developing skin cancer. Some of the best clinical studies were published in Australia where the skin cancer rates are very high.

The is the same thing that is happening with polyps of the colon that are at risk of developing into colon cancer. These colonic polyps are identified and removed…..but identifying and treating actinic keratoses is easier than a colonoscopy.

Sunscreen and sun protective clothing will help prevent the growth of AKs, though most people got most of their exposure when they were younger. Nonetheless, clinical studies have demonstrated that regular sunscreen use and sun protection will lower the occurrence of new actinic keratoses, even in those people who already have many.