Spotting actinic keratosis before it becomes cancerous

Take a good look at your skin. Do you see any crusty, rough, scaly growths on areas of your body with lots of sun exposure, such as your face, nose, ears, bald heads, arms, and the backs of your hands? If so, then you, along with 58 million other people, may have a precancerous skin growth called actinic keratosis. Caused by years of overexposure to the sun, these usually harmless growths have the potential of turning into squamous cell skin cancer, the second most common type of skin cancer.

What is actinic keratosis?

Actinic keratosis (AK) is caused by years of exposure to ultraviolet (UV) rays from the sun or indoor tanning beds.  It’s important to see a dermatologist as they are considered precancerous and if left untreated, they may turn into a type of skin cancer called squamous cell carcinoma.  Most people get more than one and when they do, it is then called actinic keratoses, or AKs.

Actinic keratosis is not the same thing as seborrheic keratosis, which is usually a harmless skin growth.  Seborrheic keratosis can vary in appearance; most are usually white to tan to dark brown and have a rough, wart-like surface that can make them appear “stuck” on the skin.

Actinic keratosis (AK) usually start off as small – most are less than a quarter-inch across – often pinkish-red or flesh-colored so that you may not notice in the beginning. Sometimes AK can go away, but will often return.  They tend to be slightly elevated and can feel like sandpaper when rubbed. They are commonly painless but sometimes may itch, feel tender, or become inflamed.

The majority of the time, AKs do not develop into skin cancers.  However, it’s highly recommended to have a dermatologist check them out and treated before they might become a problem.

Who is more prone to developing AKs?

Those most prone for developing AKs are fair-skinned people, with light-colored hair and eyes.  Generally most AKs appear in adults over the age of 40.  However, if anyone has used an indoor tanning bed or lives in a sunny climate, such as Florida or California, AKs may form at an earlier age.  Others who are at a high risk for formation of AKs are anyone with a weak immune system or has a condition that makes them sensitive to UV rays.

Diagnosing AKs

To diagnose AKs, a dermatologist can simply look at a person’s skin or feel the skin. Sometimes, a biopsy may be needed which is usually done during an office visit.  Either the entire growth is removed or a part of it.  The removed skin is sent to a lab to be examined under a microscope.

Treatment options

If you suspect you may have AK, see your dermatologist. There are several treatment options available and a dermatologist can recommend the best approach based on the size and number of growths and where they appear on the body.

Here are some common treatment options:

• • Liquid nitrogen – If you have a single AK or small ones, the dermatologist can freeze them with liquid nitrogen. While there is a stinging sensation, it is not painful for most people. After the procedure, the area turns into a blister in a few days and then the lesion falls off

• • Topical creams – Applied once or twice a day for 3-4 weeks, creams are used to treat clusters of AKs on larger areas like the scalp, arms, and legs. The creams contain 5-fluorouracil (5-FU), a chemotherapy drug that causes AK cells to break down and die before they become cancerous.

• • Photodynamic therapy (PDT) – Anyone who is not able to use a topical cream can use a one-time treatment of PDT. This 15-minute treatment involves applying an ointment that sensitizes the affected skin to ultraviolet rays. The drug is absorbed by the sun-damaged cells, and then the area is exposed to high-intensity blue light.  The light causes the drug to form high-energy oxygen compounds that are toxic inside cells. For several days following the treatment, your skin may look like you have mild sunburn.

• Immune stimulators – A commonly prescribed immune stimulator called imiquimod cream, is another possibility of treating AK by helping the immune system kill AK cells. While it is an alternative to topical 5-FU, it has been found by studies to not be as effective.