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Actinic Keratosis

Definition:
Actinic keratosis is precancerous localized skin growths on sun-exposed areas.

Years of cumulative sunlight (ultraviolet) exposure damages skin and causes it to grow abnormally. Patches on skin pale or redden to produce a mottled appearance, then rough, scaly or crusted areas develop that are usually pink but can be gray. Sometimes a small “horn” of fingernail-like material grows. These lesions are more common in older men, probably related to occupational exposure. They are benign, but they occasionally convert to squamous cell skin cancer and must be surgically removed. People with sun-damaged skin should see a physician at regular intervals to check for skin cancer.

Causes:

  • Sun exposure
Risk Factors:
The following factors increase your chances of developing actinic keratoses. If you have any of these risk factors, tell your doctor:
  • Fair complexion
  • Easy sunburning
  • Cumulative exposure to sun
  • Occupations or pastimes in sunlight (e.g., farmer, lifeguard, outdoor sports)
Symptoms:
If you have these lesions on your skin, do not assume they are actinic keratoses. These skin lesions may be cancer or another serious condition. If you find one of them, see your physician.
  • Mottled red and white, thinning skin on sun-exposed areas
  • Rough, scaly, or crusted patches on sun-exposed areas
Diagnosis:
Your doctor will ask about your symptoms and medical history and perform a physical exam. You may be referred to a dermatologist.

Tests may include the following:

  • Biopsy of the lesion to look for cancer.
Treatment:
Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Surgical Removal
Individual lesions can be curetted (scraped with a circular cutting instrument under local anesthesia) or shaved with a scalpel. If there is a question of cancer, a biopsy specimen will be sent for microscopic examination.

Cryosurgery
Liquid nitrogen or a freeing spray kills the abnormal tissue, allowing normal healing to replace the lesion.

5-fluorouracil (5-FU) Cream
Applied twice a day for 2-4 weeks, 5-FU selectively attacks damaged skin so that normal skin can grow in its place. The result is temporary redness and rawness (like a bad sunburn), but the worse the reaction, the better the final result. This is the treatment of choice for badly sun-damaged skin with multiple actinic keratoses.

Chemical Peeling

Various acids can destroy superficial layers of skin, allowing normal skin to heal over the damage.

Photodynamic Therapy (PDT)
A chemical, 5-aminolevulinic acid, applied to the skin sensitizes the abnormal growths to light. If they are then exposed to strong light, the keratoses are destroyed.

Prevention:
To help reduce your chances of getting actinic keratoses and skin cancer, take the following steps:
  • Avoid sun exposure.
  • Wear long sleeves, long pants or a long skirt, and a wide-brimmed hat when outdoors, especially during the middle of the day.
  • Use sun screen with an SPF of at least 15.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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