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actinic keratosis

Actinic keratosis (also referred to as solar keratosis, or AKs) is a sun-exposure condition which displays as thick, scaly, or crusty patches of skin. It is common in fair-skinned people who are repeatedly exposed to the sun in tanning, outdoor sports such as golf, tennis and in those who work outdoors. It is usually accompanied by other sun damage such as premature wrinkling and pigmentation irregularities.

Because men tend to spend more unprotected time in the sun, the incidence of both AK and skin cancer seems to be higher for men. It is often a wife who insists her husband see a dermatologist to “check out” a scaly growth.

Spots or growths usually begin appearing after the age of 50, though may develop earlier in sunny climates such as we experience here in Southern California. Since some of these pre-cancers can progress to squamous cell carcinoma (skin cancer), they should be evaluated and treated as they appear.

Why should I be concerned about AK?

Why should I be concerned about Actinic Keratosis? AK can be the first step in the development of skin cancer. Because of this potential it is a possible precursor of cancer or a “precancer”.

If treated early, almost all AKs can be eliminated without becoming skin cancers. Left untreated, about 2 to 5 % of these lesions may progress to a skin cancer called squamous cell carcinomas.

Some scientists believe that AK is the earliest form of SCC. These cancers are usually not life-threatening, provided they are detected and treated in the early stages. However, if this is not done, they can grow large and invade the surrounding tissues and, on rare occasions, metastasize or spread to the internal organs.

Another form of AK, actinic cheilitis, develops on the lips and may evolve into a type of SCC that can spread rapidly to other parts of the body.

If you have AKs, it indicates that you have sustained sun damage and could develop any kind of skin cancer - not just squamous cell carcinoma. The more keratoses that you have, the greater the chance that one or more may turn into skin cancer. People may also have up to 10 times as many subclinical (invisible) lesions as visible, surface lesions.

Multiple Actinic Keratosis on the Scalp
Multiple AKs on the Scalp

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What causes Actinic Keratosis?

Actinic keratoses are caused by sun exposure over long periods of time. The genetic structure of the skin is changed by UV exposure, allowing for abnormal skin growths to occur. These skin growths start out as flat scaly areas that feel rough, similar to sandpaper in texture, and later evolve into a tough, wart-like area.

Where do Actinic Keratoses lesions occur and how do I detect them?

An actinic keratosis growth commonly ranges between 2 and 6 millimeters in size, and can be dark or light, tan, pink, red, a combination of all these, or have the same coloring as surrounding skin. It may appear on any sun-exposed area, such as the face, ears, neck, scalp, chest, backs of hands, forearms, or lips.

You will sometimes feel the presence of an AK lesion before you see it.

How do I know if it is Actinic Keratosis or something else?

A dermatologist can usually identify AK by doing a thorough visual examination. A biopsy may be necessary when the keratosis is large and/or thick, to make sure that the bump is a keratosis and not a skin cancer.

Seborrheic keratoses are other bumps that appear in groups like the actinic keratosis but are not caused by sun exposure, and are not related to skin cancers. Seborrheic keratoses may be mistaken for an actinic keratosis. Dr. Sikorski recommends that you not take chances with any unusual or abnormal skin growth. Delayed evaluation can result in prolonged treatment or the diagnosis of potential skin cancer.

How is Actinic Keratosis treated?

Liquid nitrogen, or "freezing off" the AKs.
Actinic Keratosis Peel
5-fluorouracil to activate chemical peeling
Photodynamic therapy: Light activated therapy involves applying a solution which makes AKs more sensitive to any form of light
Laser resurfacing (MiXto) is often to treat with diffuse AKs.
Immunotherapy: topical treatment with imiquimod (Aldara), an immune enhancing agent (See link to Imiquimod below for more information)

Regular follow-up after treatment is advised. The regular checks are to make sure new bumps have not developed and that old ones haven't become thicker.

How can I prevent Actinic Keratosis?

Prevention is very important. Sun protection can reduce the number of new areas occurring and may help small lesions go away on their own. If you are being treated for AK's it is extra important to adhere to your doctor's precautions.
Avoid direct sun in the middle of the day (10 AM to 3 PM). Remember: snow and water reflect light to the skin, and clouds still let a lot of light through, so you may still be exposed to ultraviolet light even on cloudy days.
Use a hat with a wide brim. A baseball hat does not give much protection.
Cover up with tightly woven clothing. Some manufacturers make specialty clothing with a high sun protection factor (SPF) rating, or you can purchase a special ingredient to be added to your washer that can "wash" SPF into your clothing.
Use sunscreen on all exposed skin areas, including the lips, before going outside. A broad spectrum (blocks both UVB and UVA light), with an SPF of at least 30, is best. Apply generously 30 minutes before going outdoors and reapply every 2 hours or after swimming or sweating a lot.
Do not use tanning beds.
A low-fat diet (less than 21% calories from fat) has been shown to reduce the incidence of actinic keratoses.

View Sun Damaged Skin Slide Show

Resources

CDC
Sun Exposure Protection Guide
National Library of Health
Imiquimod
Graceway Pharmaceuticals
Aldara.com
American Academy of Dermatology
Actinic Keratosis Site
DusaPharma
Levulan

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