Actinic Keratoses (precancers)

Actinic keratoses (AKs) are lesions on the surface layer of the skin (epidermis) caused by chronic exposure to sunlight, particularly ultraviolet light. AKs occur when the cells that comprise 90 percent of the epidermis, the keratinocytes, change their size, shape and/or organization in a process called cutaneous dysplasia. AKs typically manifest as rough or scaly skin, bumps, mottled patterns and cutaneous horns. They may appear anywhere on the skin surface exposed to sunlight, but common areas include the face (including ears and lips), neck, arms and hands. Lesions range in size from a pinpoint to several centimeters in diameter and may be yellow, brown, red or violet, smooth, wrinkled or furrowed.

Actinic keratoses can signal the onset of skin cancer; they can become squamous cell carcinomas, the second-most common form of epidermal skin cancer. For this reason, during the treatment process, surgical biopsy is frequently performed on AKs to determine whether cancer has developed.

Depending on a number of factors such as the size, location and severity of lesions, as well as the patient’s age, health, medical history, occupation, expectations and preferences, treatment for AKs may take the form of traditional surgical excision, cryosurgery (freezing), curettage (scraping), topical medications, laser treatment, chemical peels, dermabrasion and pulsed light therapy.

Causes Of An Actinic Keratosis

Such a lesion is typically caused by chronic exposure to sunlight, particularly ultraviolet light and is therefore mainly found on areas of the body most frequently exposed to the sun. While not a skin cancer, an actinic keratosis, left untreated, may develop into an squamous cell carcinoma, a form of skin cancer capable of metastasizing and even resulting in death. Although not dangerous in itself, an actinic keratosis must always be taken seriously and examined and treated by a dermatologist.

Symptoms Of Actinic Keratosis

AKs An actinic keratosis appears as a scaly reddish or tan lesion on the epidermis, or surface layer of the skin. It may manifest as rough or scaly skin, bumps, mottled patterns, or protrusions called cutaneous horns. Actinic keratoses usually appear on the face, including the ears and lips, or on the neck, arms and hands.The lesions may range in size from a pinpoint to several centimeters in diameter and may be yellow, brown, red or violet in color, and smooth, wrinkled or furrowed in texture.

Risk Factors For Actinic Keratosis

Fair-skinned individuals, aged 40 to 50 years of age, are more prone to actinic keratosis. Nonetheless, individuals of any age may develop such lesions, particularly in warm, sunny climates. Teenagers are often diagnosed with the condition. Actinic keratosis is also more likely to occur in individuals who spend a great deal of time in the sun, or who frequent tanning parlors.

Diagnosis Of Actinic Keratosis

A dermatologist should always be consulted about any suspicious lesion on the skin. Unless such a lesion is immediately identifiable by the physician as benign, a surgical biopsy may be performed to determine whether it is premalignant or cancerous. The biopsy procedure is small and painless and takes place in the doctor’s office. A pathology report will be available in a week or two to determine whether further treatment is necessary.

Treatment Of An Actinic Keratosis

Depending on the location and severity of the lesion, an actinic keratosis may be treated in a number of ways. The patient and doctor will decide on methodology in consultation.

These may include:

Cryotherapy, or freezing
Curettage, or scraping
Application of cream or ointment
Chemical peeling
Photodynaminc therapy using laser light
Prevention Of Actinic Keratosis

Because individuals who have had an actinic keratosis are more likely to have another lesion of this type and are also at greater risk of developing a squamous cell carcinoma, they should always opt to have full body checks with their dermatologist at regular intervals. Patients who have been treated for this condition should also avoid sunlight as much as possible. When they are exposed to the sun, they should be careful to wear adequate protection, including sunscreen with an SPF of 30 or higher, protective sunglasses, long sleeves and long pants whenever possible, and wide-brimmed hats. They should also, of course, avoid tanning parlors.