Actinic keratoses (AKs) are considered precancerous. That means these are the earliest stage in skin cancer development. If left untreated, they may develop into squamous cell carcinoma, which has the potential to be dangerous. They develop in fair-skinned people from chronic sun exposure and tend to occur in sites of high exposure to sunlight, such as the scalp of bald men, the backs of the hands, faces, lips, and ears.
Actinic keratoses appear as scaling, dry, and sometimes sensitive spots that are reddish or brown in color. They do not clear up with moisturizers, and if picked off, they grow back. Sometimes they will temporarily appear to resolve but then return at the same place.
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Multiple treatment modalities can be administered. The most common form of treatment is cryotherapy with liquid nitrogen. This is applied to the individual spots of actinic keratosis, freezing and destroying the atypical cells. Redness and blistering occur, but usually resolve in one to two weeks. In most cases, there is no long-term mark left on the skin.
In people with many actinic keratoses, field therapy may be advised. This attempts to treat lesions, which may be present and developing but are not necessarily clinically obvious. Treatment may be with a chemotherapy cream such as 5-fluorouracil or other topicals, such as imiquimod or ingenol mebutate. The cream is applied to the affected area such as the entire scalp or face for a length of time depending on the agent used (this can be as long as several weeks). Marked redness and crusting may occur. After treatment, the skin tends to be smoother and healthier in appearance.
Another approach to field treatment of actinic keratoses is photodynamic therapy, also known as PDT or "blue light." A natural chemical is applied to the skin, which is then exposed to blue light. The blue light activates the chemical to destroy the actinic keratosis. Redness and peeling like a sunburn typically occur and heal over about a week.
Prevention of actinic keratoses involves use of hats, sunscreens, protective clothing, and avoidance of excessive exposure to sunlight.
Learn more about the treatment and prevention of actinic keratoses. Philadelphia-area patients can contact Dr. Elizabeth Spiers' office to schedule an evaluation. Call (215) 230-4592.