An actinic keratosis is a scaly lump that forms on sun exposed skin surfaces.
Actinic keratosis is also called AK, solar keratosis or sun spots. They are generally the same colour as the skin but can become pigmented. The scale or crust is dry, and rough, and often is noticed by touch rather than sight. Actinic keratosis may disappear when the crust falls off or is picked off but will usually reappear until treated. About half will go away on their own if you avoid sun for a few years. AK’s generally appear on sun exposed areas like the face, ears, backs of hands, scalp, neck, forearms, and lips.
Actinic keratosis can be a precursor to skin cancer. About 10 to 15 percent of active AK’s, which are more tender and redder than the rest will progress to SCC (squamous cell carcinoma). The most aggressive form of AK, actinic cheilitis, appears on the lips and can evolve into SCC. When this happens, about 20% of these skin cancers spread to other parts of the body. People with actinic keratosis are more likely to develop melanoma also. Sun exposure is the cause of almost all actinic keratoses. It is lifetime sun exposure, not recent sun-tanning that adds to your risk. Up to 80% of sun damage is thought to occur before the age of 18. UV rays bounce off reflective surfaces like sea and snow; about 80% can pass through clouds. The thinning of the ozone layer may be allowing more ultraviolet rays reach the earth. People who have fair skin, blonde or red hair, blue, green, or grey eyes are at the greatest risk. Because their skin has less protective pigment, they are the most susceptible to sunburn. Even darker-skinned people can develop actinic keratosis if they have lots of sun exposure.
How is actinic keratosis treated?
There are a number of effective treatments for removing actinic keratoses. The decision on whether and how to treat is based on the nature of the lesion, your age, and health but large, multiple or inflamed Actinic keratoses need to be treated to prevent change to a skin cancer.
- Liquid nitrogen, one of the most common treatments, freezes off lesions through cryosurgery. Longer freezes can result in hypopigmented (white) areas.
- Surgitron curettage is another treatment. The doctor scrapes the lesion and may take a biposy specimen to be tested for cancer.
- Shave Removal uses a scalpel to shave the AK and obtain a specimen for testing. The base of the lesion is destroyed, and the bleeding is stopped by cauterizing.
- Chemical peels make use of acid applied all over the area. The top layers of the skin peel off and are usually replaced within seven days by growth of new skin. Redness and soreness usually disappear after a few days.
- Fraxel Dual is a fractional resurfacing laser which produces results similar to a chemical peel but is less likely to cause side effects.
- Topical creams like Aldara are effective in treating keratoses, particularly when lesions are numerous. Aldara works by stimulating the body's immunity to recognize the AK’s and treat them. This is used twice weekly for 6-12 weeks over the affected areas. 5-fluorouracil (Efudix) cream works by directly attacking the precancerous cells directly. This is applied once to twice daily for 2 to 4 weeks. Treatment leaves the affected area temporarily red and raw and will cause some discomfort. The more raw and inflamed the skin becomes, the better the end result.
Regular follow-up visits are usually needed when there are many keratoses.
Palm Clinic is an Affiliated Provider to Southern Cross Health Society for skin cancer treatment, skin biopsies, and skin cancer surgery. Medical necessity criteria apply.