Actinic Keratosis and Pre-Cancers

What are actinic keratoses? Actinic keratoses (AKs) are small, red, rough, scaly, flat spots that feel like dry skin patches...almost like sand paper. They occur on sun-exposed areas, such as the nose, ears, face, chest, forearms, and back of the hands. Common terms include AK, AKs, solar keratosis, precancers, and pre-skin cancers.

What causes Actinic Keratosis?
Actinic Keratosis is a result of disruption of skin cell function. Where normal skin cells turn over on a systematic basis, the cells of an AK lesion develop in a haphazard fashion. This is primarily the result of UV exposure from the sun over the years. DNA alterations cause these cells to clump, enlarge and project from the normally smooth epidermal tissue. Although not a cause for alarm, they should be checked to rule out the possibility of early skin cancer. Most patients choose to treat AKs as a preventive measure and also to restore smooth skin. AKs tend to grow larger over time and become more difficult to remove if left unattended.

Actinic Keratosis on the Face

What are the chances of AKs becoming skin cancers?
Anywhere from 5%-10% of AKs can potentially go on to become skin cancers. It is not possible to tell which ones will do this. Some AKs will never develop into anything else. Some AKs go away without treatment.

Do actinic keratoses ever turn into melanoma (a deadly form of skin cancer)?
No. While AKs may give rise to skin cancers like squamous cell carcinomas, they do not turn into melanomas. Nevertheless, it is important to keep in mind that people with AKs may be more prone to melanomas simply by having more sun damage.

How is Actinic Keratosis treated?

• Liquid nitrogen, or "freezing off" the AKs -- usually requires repeated treatments as liquid nitrogen only affects visible lesions
• 5-fluorouracil to activate chemical peeling Efudex. Requires continued application even when skin has been sensitized. More difficult therapy for those with sensitive skin or outdoor lifestyle.
• Photodynamic therapy (PDT): Light activated therapy involves applying a solution which makes AKs more sensitive to any form of light. 1 to 3 treatments depending on number of actinic keratosis lesions and their depth.
• Laser resurfacing with Fraxel Re:pair Laser is a new treatment choice for diffuse AKs. This treatment also improves skin color, texture and offers various levels of tightening.Single treatment.
• Burning off AKs with electricity.
• Fraxel Re:store series based gentle laser FDA approved for AK removal
• Immunotherapy: topical treatment with imiquimod (Aldara), an immune enhancing agent
  
  *PDT and Fraxel Re:pair or Fraxel Thulium provide the most efficient and fastest resolution of AKs but do involve a higher cost than topical products or individual lesion removal

How do I prevent developing more precancers?
Helpful measures include sun protection with hats, clothing, sunscreen, and sun avoidance, particularly during the peak hours of 10 a.m. to 4 p.m. Additional long-term maintenance options include nightly applications of retinoid creams, such as tretinoin (Retin-A) or tazarotene (Tazorac). Some studies also have shown a benefit from using green tea creams to decrease the number of AKs.

How do I know that my AK is not cancerous?
Any non-healing or recurring AK in the same spot may need a small skin biopsy to make sure it has not turned into skin cancer. Sometimes, we will treat the AKs and recheck them in three to four weeks. Any non-healing spots may then be suspect for possible cancer.