Actinic Keratosis

Actinic Keratoses: Precancerous Spots

One of the most common problems that patients develop, particularly as we age a bit, are the precancerous spots known as actinic keratosis, or AK.

AKs are scaly, reddened to brown, growths on the sun exposed areas of the skin. They are common on the face, very common on the ears, and often develop on the bald man’s scalp, as well as arms and legs.  The lesions may be “horny” or not, and may be small and discrete or spread out in a lesion dermatologists refer to as a “plaque.”

Not all AK develop into skin cancer. However, the problem is, we cannot predict in advance which AK will develop, so they all should be treated. The type of skin cancer that results from AK is called a squamous cell carcinoma.  Squamous cell carcinoma has the potential to spread (metastasize) so they must be taken seriously.

Treatment for AK consists of one of a variety of modalities. 

Liquid Notrogen Cryosurgery or LN2

Probably the most common is to “freeze” the lesion with liquid nitrogen.  After the freezing, the lesion scabs over and sloughs off the skin.  With an adequate freeze, many AKs will disappear.

Using freezing, the lesions are treated one by one.  It is not uncommon on a severely sun damaged patient for the dermatologist to treat numerous lesions, perhaps up to 15 or so.

Electrosurgery

Electrosurgery is another destructive modality used to treat AK.  With this, an electrical current (not heat) is introduced to the AK and surrounding skin and the lesion will coagulate and slough off.  Generally, we use a bit of local anesthesia so that this is painless.

IPL OR BBL Light Treatment with ALA (Photodynamic Therapy)

AK may be treated with a combination of ALA (alpha levulinic acid or Levulan Kerastick) and light of a certain wavelength.  In this treatment, the ALA solution is painted on the skin and left to absorb for about thirty minutes.  Then, light of a certain wavelength is administered via one of several modalities including IPL or BBL, or “blue light.”

The AK becomes extremely inflamed and eventually sloughs off the skin.

Topical Chemotherapy:  5-FU or IMIQUIMOD

Another modality to treat AK is to use a topical cream applied in a broad-field manner to the affected area.  There are several products that we use, but the effect is generally an inflamed skin with destruction of the AK.  Using the topical creams, treatment is generally over an extended period of time following one of several protocols.

To Biopsy or Not to Biopsy

Patients who have numerous AKs would not find it reasonable for the dermatologist to biopsy each and every AK that we treat.  However, there are certain AKs that have a suspicious appearance to the trained eye, or in which the diagnosis of AK versus squamous cell carcinoma or other skin cancer, is not absolutely certain…that just must be biopsied.

Dr Sandy Martin at the prestigious Center for Dermatology and Skin Surgery, is very experienced in sun damaged skin and the treatment of AK and will use our best judgment as to whether any particular lesion requires a biopsy.  We encourage you to participate in this decision.