Actinic Keratoses are common precancerous skin lesions with malignant potential if left untreated. They appear on sun-exposed areas including the scalp, face, neck, extremities, upper back and hands.
What Causes Actinic Keratoses?
Actinic Keratoses are caused by cellular DNA damage due to UV rays from the sun or indoor tanning beds. This condition affects keratinocytes which are located in the outermost layer of the skin. The solar damage is accumulated over long periods and may be caused by occupational sun exposure or plenty of time spent outdoors during youth. Risk factors include fair skin and light eyes, weakened immune system, increasing age, previous history of sunburns, living in regions that are warm and sunny and prior use of indoor tanning devices.
Precancerous Actinic Keratoses are rough, scaly “sandpaper-like” patches that can be skin colored, darkly pigmented, pink or red. Sometimes the precancerous lesions are challenging to detect visually but the textural changes can be felt on the skin’s surface. Actinic Keratoses are typically asymptomatic but some patients report itchiness, a burning or stinging sensation, tenderness to touch or bleeding of the affected area. Actinic Keratoses on the lips are referred to as Actinic Chelitis which may initially be mistaken for chapped lips by many patients.
A certain percentage of Actinic Keratoses progress into Squamous Cell Carcinoma if left untreated but it is impossible to predict which will turn into malignant lesions therefore all precancerous lesions are treated in an effort to prevent skin cancer. The type of treatment depends on the overall number of Actinic Keratoses, as well as their location and distribution.
The most common form of treatment is cryotherapy which involves freezing the precancerous lesion with liquid nitrogen.
Topical chemotherapy creams including 5-Fluorouracil (Efudex) cream and imiquimod are other options that require prolonged home use and may not be well tolerated by patients.
Photodynamic therapy (PDT) or Blue Light Therapy is referred to as “field therapy” and is helpful in both the treatment of current Actinic Keratoses and the prevention of new lesions. PDT is used to treat a larger area like the face, chest or scalp versus treating individual spots. A benefit of PDT is that it can be used to treat lesions that may not be clinically detectable yet. During a PDT appointment the area is first prepped and cleansed with acetone to eliminate any dirt or oil on the skin’s surface. Then, a photosensitizing gel is applied to the affected area and allowed to soak into the skin for upwards of 45 minutes to a couple of hours. After appropriate incubation time, patients are brought back to sit under the blue light for 15-20 minutes of light exposure. Patients are advised to avoid the sun completely for 48 hours following completion of treatment. Subsequent PDT incubation periods are tailored to the patient’s response to treatment. In general, to help prevent further sun damage and the development of a precancerous lesion, it is important to use SPF 30+ or sun-protective clothing when spending time outdoors.
Chemical peels and resurfacing lasers are other methods to treat this condition.
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Are you concerned about precancerous skin lesions? Contact our Venice, FL office for an appointment with one of our board-certified physicians for diagnosis, treatment and care.