Actinic Keratosis

What are actinic keratoses?

Roughly translated, “actinic” means sun-related, and  keratoses  are rough, scaly skin lesions or growths. There are many different types of keratoses, but actinic keratoses, or AK’s, are precancerous. If left untreated, they may become skin cancers called squamous cell carcinoma.  Squamous cell carcinoma has the potential not only to invade adjacent structures, but also to spread distantly (metastasize).

AK’s occur on any “sun-exposed” skin – face, bald scalp, lips, tops of hands, arms, chest, upper back and, less frequently on the lower extremities.

They are scaly crusty growths that can be red, pink, white or brown. They may be very raised like a wart or a horn, or so flat you only feel them when you run your finger over them.

Who is at risk for getting actinic keratoses?

People at risk include those with fair complexions, light hair or light eyes, a past history of prolonged or frequent sun-exposure ( lifeguards, construction workers, car salespeople, landscapers, roofers, boat enthusiasts, pool owners, tanners), and people who have lived in sunny areas.

As we age, cumulative sun exposure increases and actinic keratoses develop with increasing frequency.

Why are actinic keratoses important if they aren’t cancerous?

Actinic keratoses are made of the same abnormal cells seen in squamous cell carcinoma. It is impossible to predict when or which keratoses will be the ones to become invasive into deeper tissues or even spread to surrounding or distant areas. Statistically speaking, the more AK’s you have, the greater the risk for progression of one or some to skin cancer.

How can I prevent actinic keratoses?

Follow the recommendations put forth by The Skin Cancer Foundation to minimize sun damage:

  • Seek shade or avoid sun altogether between 10 AM-4 PM
  • Do not burn
  • Avoid tanning and never use tanning beds
  • Use protective clothing including a broad-brimmed (5 inch) hat and 100% UV protective sunglasses
  • Use a broad spectrum (UVA/UVB) sunscreen (I recommend chemical free ones with zinc oxide and titanium dioxide with SPF 30 or higher daily)
  • For your face and body use a shot glass amount. For your face, use a teaspoonful
  • Keep newborn babies out of the sun. Use sunscreens (chemical free) on babies 6 months or older
  • Check your skin head-to-toe every month
  • See your dermatologist every year for a professional skin exam

How are actinic keratosis treated?

Fortunately many therapeutic methods are available. Individual lesions can be easily treated with cryotherapy, which is freezing. When it dries, it falls off and the AK does with it.

Field treatment is the use of a topical agent to treat the entire “field” of sun-damaged skin. There are multiple FDA approved agents now on the market for field treatment of AK’s.