Actinic keratoses (AKs) are common skin cancer growths. In fact, these growths are so common that treatment for AKs is one of the most frequent reasons that people see a dermatologist.
AKs are caused by years of ultraviolet ray (UV) exposure from the sun or indoor tanning beds.
AKs are considered precancerous. Left untreated, AKs may turn into a type of skin cancer called squamos cell carcinoma.
It is important to see a dermatologist if you suspect you have AK.
What do AKs Look Like?
Most AKs share common qualities such as being dry, scaly, and rough textured. Not all AKs look the same though. Some are skin colored and may be easier to feel than see. These AKs often feel like sandpaper Other AKs can appear as red bumps; thick scaly red patches or growths; or crusted growths varying in color from red to brown to yellowish black. A single AK may range from the size of a pinhead to larger than a quarter.
Sometimes an AK grows rapidly upward, and you see a growth that resembles the horn of an animal. This is called a “cutaneous horn.” Horns vary in size from that of a pinhead to a pencil eraser. Some horns grow straight; others curve. Cutaneous horns often form on men’s ears.
AKs often seem to fade or appear less prominent for weeks or months and then return. This makes treatment important. Left untreated, the damaged cell can continue to grow and skin cancer may develop.
When AKs develop, they tend to appear on skin that received the most sun, including the:
- Forehead, neck, chest, ears
- Scalp, especially a bald scalp
- Arms or hands
- Lower legs, especially in women
AKs also commonly form on or at the border of the lip. An AK on the lip is known as “actinic cheilitis” and looks like a white or greyish scaly patch on a dry, often cracked lip.
Who Gets AKs?
Fair-skinned people, with light colored hair and eyes, have a higher risk for getting AKs than the general public. Most AKs appear in adults over the age of 40. If you have used an indoor tanning bed or if you live in a sunny climate, such as Florida or California, you may find AKs on your skin earlier. Those with weak immune systems or who have a condition that makes them sensitive to UV rays, are also at high risk.
How Does a Dermatologist Diagnose AKs?
Your dermatologist can diagnose an AK simply by looking or feeling them. In some cases, a biopsy is needed.
Your dermatologist can perform a biopsy during an office visit. To perform a biopsy, your dermatologist will remove the entire growth or a part of it. The removed kin will be sent to a lab where it will be examined under a microscope.
How do Dermatologists Treat AKs?
When detected early, AKs can be unsuccessfully treated. Dermatologists may use one or several therapies. Treatments available in a dermatologist’s office include:
This is the most common treatment for AKs. It involves freezing the skin cells with liquid nitrogen to kill them and remove the AK.
A light-sensitive solution is applied to the skin followed by exposure to a special light to destroy the AK.
A procedure that removes AKs by cutting or scraping (curettage). This can be combined with heat (electrosurgery) to destroy diseased skin cells.
A chemical solution is applied to the skin to penetrate the skin deeply to destroy an AK.
Laser Skin Resurfacing
A laser is used to remove AKs. Your skin type will determine which laser is right for you.
Some treatments are prescription medications that you apply to your skin. If you are prescribed one of the following medications, you will apply it at home as directed by your dermatologist.
5-fluorouracil is a cancer-fighting cream that you apply to the AK. The skin will become raw and irritated. As it heals, healthy skin appears. Another treatment such as cryotherapy may be necessary to treat thick AKs.
Imiquimod cream and ingenol mebutate fel are medications that work with the body’s immune system to help destroy AKs.
Nsaid (Non-Steroidal Anti-flammatory drug)
Diciofenac sodium gel is a medication tha you apply to your skin and is recommended for skin with many AKs. It is an anti-inflammatory and anti-cancer treatment that fades AKs over a 30 day period.
Additional in-office treatments may be needed following treatment with some of these topical prescriptions.
Sometimes, an entire body part, for example a bald man’s scalp, may have lots of AKs. In this instance, your dermatologist will need to treat the entire body part either at home or in the office.
Research and development of other treatments for AKs is ongoing. No one therapy works on all AKs or in all individuals.
How can I Prevent AKs?
Protecting your skin from the sun and other sources of UV light, such as tanning beds, is important. This helps prevent new AKs and reduces the risk of AKs returning after treatment. To protect your skin:
- Seek shade when appropriate, remembering that the sun’s rays are strongest between 10AM and 2PM. If your shadow is shorter than you are, seek shade
- Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible
- Generously apply sunscreen daily. Sunscreen should have a sun protection factor (SPF) of 30 or higher, offer broad spectrum protection (both UVA and UVB protection) and be water resistant. Sunscreen should be applied at last 15 minutes before going outdoors to all skin that will be exposed such as the face, ears, and hands
- Reapply sunscreen every 2 hours, after swimming or sweating, even on cloudy days
- Do not use tanning beds or other indoor tanning devices. Tanning beds and sun lamps emit UV rays that can be stronger than the rays from the sun
- Protect your lips with a lip balm with an SPF of 30 or higher
Check your skin as often as your dermatologist recommends. Contact your dermatologist immediately, if you notice a growth on your skin that has any of the following traits:
- Starts to itch or bleed
- Becomes noticeably thicker
- Changes in size, shape, or color
- Remains after treatment
A board-certified dermatologist is a medical doctor who specializes in treating the medical, surgical, and cosmetic conditions of the skin, hair, and nails. Dr. Daniel Behroozan and Dr. Lubomira Scherschun are board-certified to treat AKs and a variety of other medical conditions.