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05-26-11 | Posted by

When I think of skin cancer, I immediately think melanoma, the most serious and deadliest form of skin cancer, which forms in the cells that produce melanin.  But, little did I know that precancerous lesions, such as Actinic Keratosis (AK), the most common precancer, affect more than 58 million Americans.

Actinic Keratosis—also known as solar keratosis—is a precancerous skin condition brought on by sun exposure and often appears on the face, forearms, chest and back, but can also surface anywhere on the body.  The lesions tend to be raised and are usually scaly or crusty, and more common in those with fair complexions—blond or red hair and green or blue eyes—and those who have a history of burning, not tanning.

More often times with AK cases there is not just one lesion, which is why it’s often called keratoses, and usually the first steps in developing skin cancer.  Lesions tend to develop slowly and sometimes even disappear to only reappear later on.  New York dermatologist and educational spokesperson for the Skin Cancer Foundation Dr. Julie K. Karen says, “Actinic Keratoses are premalignant lesions.  If left untreated, a proportion of AKs will progress to non-melanoma skin cancer.  Most commonly, these lesions evolve into squamous cell carcinoma, although recent evidence indicates that they may also progress to basal cell carcinoma.  The exact percentage of AKs that progress to skin cancer is not known, but is likely in the three to ten percent range.  As most patients have multiple lesions, this risk is significant. Another way of thinking of it, however, is that forty to sixty percent of squamous cell carcinomas begin as AKs.”

According to the National Council on Skin Cancer Prevention, the number of women under age 40 diagnosed with basal cell carcinoma (forms in the basal cells, which line the deepest layer of the skin) has more than doubled in the last 30 years while squamous cell carcinoma (forms in the squamous cells that make up the skin’s upper layer) has also significantly increased. If you do develop Actinic Keratosis, it is an indicator that you have sun damage and can lead to any type of cancer, not only squamos cell carcinoma.

What Characteristics to Look for:

Rough, sandpaper texture

Small, but noticeable, red, brown or skin-colored patches that don’t go away

Spots that itch or have a tender sensation

Lesions that range in size from 1mm to 3mm or larger

Red or irritated lesions

The good news is that most cases of Actinic Keratosis can be treated, and the earlier you spot this condition the better.  Staying out of the sun will prevent the condition from getting worse.  “First and foremost, one should take steps towards prevention of these lesions,” says Dr. Karen.  We know that only a small percentage (about 22 percent) of one’s sun-induced damage takes place prior to age 18.  The remainder accumulates over the subsequent decades.”

Early diagnosis is key. If you notice something unusual or changing in size visit dermatologist for a proper skin exam and diagnosis.

How to Protect Your Skin:

Wear a broad-spectrum sunscreen on the face, back, arms and chest, and reapply every two hours or immediately after swimming or excessive sweating

Wear a hat or other protective gear if out in the sun

Seek shade between 10 a.m. and 4 p.m.

See a dermatologist every year for a full skin exam

Avoid tanning and indoor tanning beds

Treatments for Actinic Keratosis:

A doctor may recommend one or a combination of the following treatments for those with Actinic Keratosis.

For isolated cases:

Cyrosurgery – Liquid nitrogen is applied to skin to kill damaged cells

Shave removal – Scraping of the lesion with a scalpel under local anesthesia

For multiple lesions in a large area:

Topical Ointments – Includes 5-Fluorouracil or Imiquimod, both FDA-approved topical medicines, which destroy the growth of certain cells, and Diclofenac, a non-steroid anti-inflammatory drug

Chemical Peels – Slough off the upper layer of skin; a good option for AK cases on the face

Phytodynamic therapy – A specific topical solution is applied to the skin and activated by a laser, which kills abnormal cells.

Laser Therapy –Removes lesions and affected skin underneath. Most recently, the Fraxel laser has been approved to treat AKs.

For more information on precancerous lesions and Actinic Keratosis visit skincancer.org or aad.org

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