Actinic Keratosis

General:

Actinic Keratosis are often referred to as pre-cancers. They are areas of ultraviolet radiation induced skin mutations resulting in a superficial level of damage. Overtime they have the ability to transform into a skin cancer. They are not precursors to melanoma, rather to the much more common variety of skin cancer called squamous cell carcinoma. Refresh your memory on the skin cancer types here.

Where do they occur?

They typically occur in the areas with the most cumulative lifetime sun exposure such as the temples, forehead, scalp, cheeks, hands, forearms but can occur anywhere frequent sun exposure has occurred over the years.

What do they look like?

They are often described as being “better felt than seen”. That is, they may initially present as an area of persistent rough, sandpaper-like textural change in the skin that is difficult to appreciate visually. Eventually a red patch with overlying sharp adherent scale is noted when well formed. Some people may just have one or others may have hundreds with regions of diffuse confluent damage. There is sometimes a sensitivity to the skin when the lesions are felt.

How often do they turn into skin cancers?

The rate of transformation to squamous cell carcinoma is not known precisely but is probably less than 1% (per spot, per year). That risk becomes more significant when patients have multiple spots and multiple years ahead of them. Should transformation to a skin cancer occur it may present with increased thickness, increased pain, rapid growth, spontaneous bleeding. Inform your doctor immediately should this occur.

How are they treated?

Actinic Keratosis can be treated with a variety of methods. It is far easier to treat them in the precancer stage than waiting to see if they become skin cancers. The two most common approaches for pre-cancers include liquid nitrogen destruction and treatment with a topical chemotherapy cream (fluorouracil). We often use a combined approach in patients with multiple lesions.