Precancerous skin lesions, also called actinic keratoses, may evolve over time into cancer if not properly treated. The key to prevent skin cancers is the early diagnosis and treatment of actinic keratoses. Dr. Matsuda, Dr. Sheu, and Dr. Jim On in Honolulu, HI offer many effective therapies.
WHAT IS ACTINIC KERATOSIS (AK)?
This condition manifests as scaly, rough patches growing on the skin which are caused by long-term sun exposure. This symptom is found mostly on the scalp, lips, ears, face, neck, hands, forearms, and other areas commonly exposed to the sun.
Actinic keratosis may vary in different dimensions. Its color can range from light to dark, or even the same color as your current skin, to pink or red. It can grow from a pinhead to patches bigger than a quarter. It may be flat or raised and may feel smooth or as rough as sandpaper.
WHO ARE COMMON CANDIDATES OF ACTINIC KERATOSIS?
More than 58 million Americans are currently diagnosed with actinic keratosis. This precancerous condition more likely targets those people who are living close to the equator. People who have a high likelihood of acquiring this precancerous condition are those with fair complexion, such as blondes and redheads, or those with grey, green, or blue eyes. Men are also slightly more susceptible to this disease since they spend more time in the sun using less sun protection products than women. Darker-colored races, such as African-Americans, Asians, and Hispanics are less susceptible to this pre-cancer.
WHAT ARE THE COMMON CAUSES OF ACTINIC KERATOSIS?
Although chronic sun exposure, as well as ultraviolet exposure through tanning machines, may trigger the disease in most cases, age can also be a factor. Since the longer you are exposed to the sun increases chances of actinic keratosis, older people are the most susceptible to the disease. It commonly affects people over the age of 40. Some studies have even shown that almost all people over the age of 80 have this condition. However, those who are even in their 20s can be affected by this skin condition, too.
WHY IS ACTINIC KERATOSIS (AK) TREATED?
Being the most common pre-cancer to squamous cell carcinoma or skin cancer, it is important for actinic keratosis to be treated ahead of time. Although not all AKs could turn into full-blown cancers, there is no test that can reliably predict which ones will in the near future. Currently, there are quite a number of effective treatments to eliminate this skin condition.
After suspecting that the disease could be an early cancer, Dr. Matsuda or Dr. Sheu may take a skin sample for a biopsy. During this in office procedure, the patient will be local anesthetized and will feel no pain. Bleeding is typically stopped using a styptic agent.
WHAT IS CRYOTHERAPY?
This is the most common treatment for actinic keratosis. It involves freezing the visible lesions using liquid nitrogen, an extremely cold liquid, with the use of a spray canister. The purpose of cryotherapy is to destroy the damaged precancerous cells that have resided on the topmost layers of one’s skin. The lesions exposed to the treatment will manifest redness and swelling and eventually shed as the blisters dry. The treatment may require repeated sessions.
WHAT OTHER TREATMENT OPTIONS ARE AVAILABLE FOR ACTINIC KERATOSIS?
A topical chemotherapy cream called 5-flurouracil (5 FU) may be applied to the skin surface for 2-3 weeks. It is a highly effective, well tolerated and relatively painless treatment that requires the patient to apply the cream at home. It can be more difficult for patients with sensitive skin or for those who cannot avoid sunlight because of an active outdoor lifestyle.
Another topical agent called Picato gel can also be used nightly to small areas for 2-3 days. It causes a sunburn reaction and is very effective in reducing AKs.
The application of Solareze gel can exhibit good results after 3 months of use.
Other options include an in office procedure called photodynamic therapy, which uses a unique topical solution Levulan, that when activated by blue light could target and kill abnormal cells. It is FDA approved for use on the face and scalp but is often used in other areas.
Topical immunotherapy may be chosen as treatment. This therapy involves applying a prescription cream called imiquimod (Aldara, Zyclara). This is an agent that stimulates the immune system in order for the body to eliminate the cancer cells. It is highly effective in many people.
Dr. Matsuda and Dr. Sheu will discuss the different treatment options and design a program that best fits the patient’s needs. It is quite common that multiple treatments will be required and different methods may be employed.
WHEN SHOULD I RETURN TO THE DERMATOLOGIST TO CHECK ON MY ACTINIC KERATOSIS?
The goal of these treatments is to completely destroy the precancerous cell growth to decrease the risk of invasive skin cancer and avoid disfiguring surgery. However, this is not always the case. Regular follow-ups with Dr. Matsuda and Dr. Sheu are recommended.
One hallmark sign of skin cancer is a lesion that bleeds or does not heal. If a certain area still bleeds or oozes weeks after AK therapy, seek the attention of Dr. Matsuda or Dr. Sheu. Although treatments for actinic keratosis are effective, lesions that just do not heal even after repeated sessions of cryotherapy or topical therapy may already indicate skin cancer.