Actinic Keratosis - Patients ask, Dr. Ringpfeil answers
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Philadelphia and Mainline Center of Dermatology and Cosmetic Surgery
Actinic Keratosis
Actinic Keratosis - Overview
Actinic keratosis is a precancerous growth on the skin. It begins 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, the risk is increased with a history of intense or life-long sun exposure, fair skin, or an impaired immune system.
Diagnosis
Actinic keratosis develops 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.
Management
A subset of actinic keratosis can progress to squamous cell carcinoma. This is more likely to occur in men compared to women, 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 keratosis 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 health concerns or failure to respond to the most common type of treatment, shallow excision may be both diagnostic and curative.
Where actinic keratosis is multiple or confluent, at sites of poor healing or with poor response to standard therapies, photodynamic therapy, topical chemotherapy or immunotherapy 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 keratosis.
Treatment and Medication
Since it is not possible to predict which actinic keratosis will progress to skin cancer of the squamous cell type, preventative medicine mandates that actinic keratosis 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 the number of treatment sessions required. Fortunately, actinic keratosis is usually very responsive to treatment.
Coping
Important aspects of coping with actinic keratosis 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 lifestyle 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 removed with treatment, which eases fear about their progression to skin cancer.
Prevention
Actinic keratoses occur because of 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.
Patients should avoid tanning beds and tan-accelerating agents, perform self-examinations monthly, and report changes to their dermatologist. Schedule your yearly routine full-body skin evaluation. (You may need more frequent examinations if you are on immunosuppressive treatment.)
Is Mohs Surgery a possible way to eliminate a spot and remove the threat of development into squamous cell carcinoma? I have a lesion that has reoccurred in the same spot in my left cheek. There was a biopsy 4 years ago that was found begin. However, this reocurrance makes we wonder if some cells were missed in the biopsy. Perhaps Mohs would be a way to remove the affected cells and check the site at the same time?
Mohs micrographic surgery is for treatment of basal cell carcinoma and squamous cell carcinoma. If neither are present, the stains will not work and the surgery is in vein.
Please consider reevaluation by your dermatologist. Depending on the nature of the benign growth 4 years ago, additional treatment is often possible, or dermatologist might suggest additional biopsy. By default, a biopsy is a representative sampling of a skin growth, not an excision that fully removes the growth and causes a more noticeable scar.