Actinic Keratosis - Patients ask Dr. Ringpfeil answers
Please feel free to use the blog below to share information about Actinic Keratosis or to ask Dr. Franziska Ringpfeil a question that might be of interest to others.
An actinic keratosis is a precancerous growth on the skin. It initiates in the epidermis, the skin's exposed layer. Normally, epidermal cells develop in a precise, controlled and systematic fashion. Healthy new cells nudge older cells toward the skin's surface to die, and form a protective layer that continually regenerates and sheds. UV-radiation damages and changes the skin's texture and color, causing blotchiness or growths, including actinic keratoses and skin cancers. Although anybody can develop actinic keratoses, risk is increased with a history of intense or life-long sun exposure, fair skin or an impaired immune system.
Actinic keratoses develop in sun-exposed areas. A single or several lesions may be present. The signs and symptoms of an actinic keratosis include a rough or scaly, flat to slightly raised bump that ranges in color from red to brown. Intermittent itching, burning or tenderness in the affected area can occur. Actinic keratoses are readily diagnosed upon professional evaluation. Rarely, further testing is needed, such as a skin biopsy, where a small sample is collected and sent for microscopic analysis.
A subset of actinic keratoses can progress to squamous cell carcinoma. This is more likely to occur in men compared to woman, with advanced age, when multiple lesions have formed or with immune suppression. The exact rate is unknown and therefore, treatment is preferred over observation. Most actinic keratoses can readily be managed with local treatment alone. The therapy is chosen with consideration to the specifics of the site, number and individual needs. In case of diagnostic concern or failure to respond to first-line treatment, shallow excision may be both diagnostic and curative. Where actinic keratoses are multiple or confluent, at sites of poor healing or with poor response to standard therapies, photodynamic therapy, topical chemotherapy or immune therapy may be necessary. Long-term follow up with your dermatologist for the associated increased risk of non-melanoma skin cancer is recommended as is the avoidance of further sun exposure in an area that has developed actinic keratoses.
Since it is not possible to predict which actinic keratoses will progress to a frank skin cancer of the squamous cell type, preventative medicine mandates that actinic keratoses be treated. Your doctor will discuss appropriate treatment for your individual lesions. Treatment options for actinic keratoses include cryosurgery, curettage, excision, chemical peel, creams that contain either anti-cancer medicines or stimulate your immune system to fight the pre-cancer, photodynamic therapy, CO2 laser ablation or dermabrasion. Each procedure has advantages and disadvantages, including discomfort, risk of scarring, duration of treatment and number of treatment sessions required. Fortunately, actinic keratoses are usually very responsive to treatment.
Important aspects of coping with actinic keratoses relate to recommended modifications in sun exposure during leisure or outdoor work, a changed appearance, seriousness of the diagnosis, control of the disease, and the sense of illness. While life style changes are easy to implement, they require discipline and constant awareness. Most of the time, a changed appearance from the original growth(s) or the treatment thereof does not require any cover up or scar revision treatments. Most actinic keratoses are easily eradicated with treatment, which eases fear about their progression to skin cancer.
Actinic keratoses occur because of cumulative sun damage that is not sufficiently repaired by our immune surveillance. In addition to limiting your time in the sun, sun protective clothing, such as a hat with a wide brim or densely woven shirts or pants, as well as application and reapplication of sunscreens with UVA and UVB filters are appropriate measures when outdoors or traveling by car. Avoid tanning beds and tan-accelerating agents. Perform self examinations monthly and report changes to your dermatologist. Schedule your yearly routine full body skin evaluation. (You may need more frequent examinations if you are on immuno-suppressive treatment.)