Actinic Keratoses

An estimated 58 million Americans have at least one Actinic Keratosis, according to SkinCancer.org.

Actinic Keratoses (AKs) are by far the most common type of precancer. Characterized by a pink or red scaly or gritty area on the surface of the skin, they may itch, burn, or feel sensitive and occasionally may bleed. AKs can often be felt before they are seen. They are predominately found on chronically sun exposed areas including the scalp, face, neck, arms, and hands. Actinic cheilitis involves the lips and causes soreness and peeling. Sometimes a hard keratin horn may be present growing off the surface of the skin.

Chronic exposure to UV radiation causes free radicals which impair the skin’s ability to fix damage. This results in abnormal changes on the cellular level. These abnormal changes present themselves as Actinic Keratosis initially, then can progress into squamous cell skin cancer if left untreated.

WHO IS AT RISK?

• Individuals who have a significant history of unprotected exposure to sun. Damage to our skin is cumulative.

• Individuals with fair skin are at a higher risk as they lack protective melanin in skin to protect them from damage. Especially those with light hair and eyes, and individuals who freckle easily.

• People over the age of 40.

• Immunosuppression due to solid organ transplants, chemotherapy, or immunosuppressive therapy for autoimmune disease.

HOW ARE THEY TREATED?

Surgically – Cryotherapy is the most common surgical treatment for AKs. Electrodessication and Curettage is another option but is not commonly used.

Topical Medication – Consists of topical chemotherapy and anti-inflammatory medications that can be used as “field treatment” on an area that has multiple lesions. The efficacy is dependent on patient application and compliance. Most of these agents can also cause photosensitivity, so patient should be thoroughly educated on the use. Depending on the medication, dosing may be once or twice a day ranging from five days to three weeks.

Photodynamic Therapy – Another option for “field treatment.” This is an in-office therapy that involves applying a chemotherapeutic agent to the area to be treated, letting it incubate for a defined period of time, then placing the patient under a blue bandwidth of light for 15-20 minutes to activate the medication.

One treatment every four weeks for three months is recommended for maximum efficacy. This can also cause photosensitivity during the 48 hours following treatment, so patient needs to be informed to avoid both direct and indirect sun exposure. Depending on patient, sometimes a combination of the above therapies is indicated.

PREVENTION

Perhaps the most important element is the prevention of Actinic Keratosis with daily use of a broad-spectrum sunscreen applied to face and arms and the use of a hat to protect the scalp, especially one with a wide brim. The recent uptick in the availability of sunscreen apparel which can provide UPF of up to 50 is an alternative for patients who don’t like the feel of sunscreen on their arms, or for those who have difficulty with reapplication of the recommended 70-90 minutes.

FOLLOW-UP

Patients diagnosed with Actinic Keratosis should be monitored every six months for new lesions and yearly for a full skin exam as they have the potential for developing a skin cancer at any time.

Written by Amy Horner, PA

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