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Actinic Keratosis: What You Need To Know

What Is Actinic Keratosis?
What Actinic Keratosis Are Not
Causes of and Risk Factors for Actinic Keratosis
Diagnosing Actinic Keratosis
Treatment Options for Actinic Keratosis
What to Expect After Treatment
Preventing Actinic Keratosis

Water’s Edge Dermatology was requested to participate in the filming of a nationwide public TV special about actinic keratosis. Alongside Water’s Edge Dermatology, you will hear from Daniel Siegel, MD, president of the American Academy of Dermatology (AAD) and Joseph Jorizzo, MD, founding Chair of Dermatology at Wake Forest University and a consultant with Water’s Edge Dermatology.

Watch the video and learn more about actinic keratosis.

What Is Actinic Keratosis?

Actinic keratosis is the most common precancer, affecting more than 58 million Americans. Actinic keratosis (AKs) are dry, scaly, rough-textured patches or lesions that form on areas of the body that have received long-term exposure to sunlight, such as the face, ears, lip, scalp, neck, forearms, and back of the hands.

While AKs share common characteristics, not all AKs look alike. Some are skin-colored and may be easier to feel than see. These lesions often feel much like sandpaper. Others can appear as red bumps; scattered, thick, red scaly patches or lesions; or crusted lesions varying in color from red to brown to yellowish black. The size of an AK ranges from a pinhead to larger than a quarter.

When an AK undergoes rapid upward growth, it becomes a “cutaneous horn,” so named because it resembles the horn of an animal. The size of a cutaneous horn may range from that of a pinhead to a pencil eraser, and the shape may be straight or curved. Sometimes skin cancer hides below a cutaneous horn.

If an AK forms on the lip, it is called actinic cheilitis (key-LITE-iss) and appears as a diffuse, scaling lesion on the lower lip that dries and cracks.

AKs Common on the Hands

AKs Common on the Hands

A fair-skinned, elderly patient with numerous crusted papules on the backs of both hands and other chronically sun-exposed parts of the body.

This retired construction worker developed these slightly tender papules and crusts on his ears over an 8-to-10-year period.

 

Be sure to see a Water’s Edge Dermatology practitioner if you notice a lesion that looks like any of the above or a lesion that begins to thicken, bleed, itch, or grow. AKs are considered the earliest stage in the development of skin cancer and have the potential to progress to squamous cell carcinoma, a type of skin cancer that can be fatal.

Anyone who develops AKs has extensively sun-damaged skin. This makes one more susceptible to other forms of skin cancer, including melanoma. Melanoma is considered the most lethal form of skin cancer because it can rapidly spread to the lymph system and internal organs.

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What Actinic Keratosis Are Not

While the terminology that dermatologists use can seem confusing, the precise terms allow dermatologists to clearly differentiate skin conditions and prescribe appropriate treatment. Described below are some skin conditions that patients may confuse with AKs. The following conditions are not AKs:

Actinic Porokeratosis
Similar in appearance to AKs, this is an uncommon, usually inherited, skin condition characterized by sun sensitivity that causes reddish brown scaly spots to develop, primarily on the arms and legs.

The lesions appear after years of sun damage to the skin, so they are typically seen in middle-aged and older individuals. The lesions tend to grow or itch after sun exposure and are fairly resistant to treatment.

Seborrheic Dermatitis
This is a red, scaly rash that itches. Seborrhea is excessive oiliness of the skin, especially on the scalp and face, without redness or scaling. If seborrhea progresses to seborrheic dermatitis, redness and scaling appear.

Seborrheic Keratosis
Also called benign keratoses, these non-cancerous growths have a waxy, pasted-on look and develop on the outer layer of skin. Lesions range in size from a fraction of an inch in diameter to larger than a half dollar. AKs are flatter, redder, and rougher to the touch than seborrheic keratosis.

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AKs Frequently Appear on Face and Ears

AKs Frequently Appear on Face and Ears

Causes of and Risk Factors for Actinic Keratosis

Years of sun exposure cause AKs to develop. All AKs, including actinic cheilitis, develop in skin cells called the keratinocytes, which are the tough-walled cells that make up 90% of the epidermis, the outermost layer of skin, and give the skin its texture.

Years of sun exposure cause these cells to change in size, shape, and the way they are organized. Cellular damage can even extend to the dermis, the layer of skin beneath the epidermis.

Other risk factors include:

  • Fair skin
  • Blond or red hair, blue or green eyes
  • Weak immune system
  • Age

AKs usually appear after age 40 because they take years to develop. However, those who live in areas that receive high-intensity sunlight year round, such as Florida and Southern California, or those who use tanning beds may develop AKs earlier.

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Diagnosing Actinic Keratosis

AKs have unique physical characteristics that allow a dermatologist to visually identify these lesions. However, if an AK is especially large or thick, the lesion may be surgically removed for microscopic examination (biopsy) to determine if squamous cell carcinoma is present.

If you find a suspicious skin lesion, be sure to see a Water’s Edge Dermatology practitioner for diagnosis, even if the lesion seems to appear and then disappear for weeks or months and reappear. Our dermatologists receive extensive medical training in skin conditions and have the experience necessary to diagnose various skin lesions. An accurate diagnosis is the first step to successful treatment.

When an AK is diagnosed, your Water’s Edge dermatologist considers a number of factors before choosing the most appropriate treatment method. Factors include:

  • Size, number, location, and stage of the lesions
  • Age, health, and medical history
  • Occupation
  • Cosmetic expectations and treatment preferences
  • Patient compliance (i.e., willingness to self-treat as needed for several weeks)
  • History of previous treatment

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Treatment Options for Actinic Keratosis

Actinic keratosis (AKs) are so common today that treatment for these lesions ranks as one of the most frequent reasons people consult a dermatologist. Treatment options include:

  • Cryosurgery (freezing the lesion off)
  • Surgical excision
  • Curettage (scraping the lesion off) with or without electrosurgery (heat generated by an electric current)
  • Topical (applied to the skin) medications
  • Laser resurfacing
  • Medical-grade chemical peels
  • Photodynamic therapy

Patients who have multiple AKs may not have all lesions treated at the same time, and in some cases, the dermatologist or dermatologic surgeon will use more than one treatment option.

Self-treating by picking off the lesions is not effective because the lesions will grow back. Since AKs have the potential to progress to squamous cell carcinoma, a form of skin cancer that can be life-threatening, AKs should be treated.

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What to Expect After Treatment

After being treated for AK, your Water’s Edge Dermatology practitioner will follow up with you for routine re-examinations. It is extremely important to keep these re-examination appointments because when enough sun damage occurs to cause AKs, the possibility of developing more AKs or even skin cancer greatly increases.

Frequency depends on the extent of the AKs, sun-damaged skin, and the treatment method. Your dermatologist may want to re-examine you as frequently as every 8 to 12 weeks or only once or twice per year.

Retreatment is sometimes necessary, as new AKs can develop and occasionally recur. In some cases, your Water’s Edge dermatologist may prescribe topical (applied to the skin) retinoids (vitamin A derivatives) to help prevent new AKs from developing.

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Preventing Actinic Keratosis

Actinic keratosis develop in skin that has been exposed to the ultraviolet (UV) light of the sun for years. Therefore, the best defense against AKs is to practice sun protection. To prevent AK and skin cancer, the AAD recommends adopting a comprehensive sun protection program that includes:

  • Avoid deliberate tanning. Ultraviolet light from the sun and tanning beds causes skin cancer and wrinkling. If you want to look like you’ve been in the sun, consider using a sunless self-tanning product. When using a self-tanning product, you should continue to use sunscreen.
  • Generously apply a broad-spectrum sunscreen with a SPF of 30 or higher to all exposed skin before going outdoors. Broad spectrum protects against both ultraviolet (UVA) and ultraviolet B (UVB) rays. One ounce, enough to fill a shot glass, is considered the amount needed to cover the exposed areas of the body properly.
  • Sunscreen should be applied to dry skin 15-30 minutes before going outdoors, and reapplied approximately every two hours, even on cloudy days, and after swimming or perspiring. Don’t forget your ears, neck, and hands. Many AKs develop in these areas. Protect your lips, another high-risk area, with lip balm that offers sun protection with an SPF of 30 or higher.
  • Get vitamin D safely through a healthy diet that includes vitamin supplements. Don’t seek the sun.
  • Cover up when you must be in the sun. Wear long sleeves, pants, a wide-brimmed hat, and sunglasses that protect against both UVA and UVB rays.
  • Use extra caution near water, snow, and sand. These reflect the damaging rays of the sun, which can increase your chance of sunburn.

When caught in the early stages, AKs and all types of skin cancer are treatable and in most cases, curable. The key to early detection is frequent skin examinations. Performing regular skin self-examinations and being screened by a dermatologist as needed can help detect AKs and skin cancer in the earliest and most treatable stages.

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[Photos used from National Library of Dermatologic Teaching Slides]

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