Actinic Keratosis
all information

Actinic Keratosis

(AK)

Pronounced: Ak-TIN-ik care-a-TOE-sis

En Español (Spanish Version)

Definition

Actinic keratosis is precancerous localized skin growths on sun-damaged 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 sun exposure. They are benign (noncancerous), but they occasionally convert to squamous cell skin cancer (carcinoma) that must be surgically removed. The rate that actinic keratosis changes to skin cancer within one year is approximately 1 in 1000. Patient that have many lesions have a higher chance of progression to skin cancer.

AKs may remain unchanged, spontaneously resolve, or progress to invasive squamous cell carcinoma. The fate of any one AK is impossible to predict. People with sun-damaged skin should see a physician at regular intervals to check for skin cancer .

Actinic Keratosis

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Causes

AKs develop because of high amounts of 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 (eg, 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 (a skin doctor).

A biopsy of the lesion may be done 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.

Imiquimod

A topical cream that treats actinic keratosis by modulating a local immune response.

Diclofenac Gel

This is applied locally and is found to be helpful in treating actinic keratosis.

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. Use of sunscreen was found to reduce the rate of actinic keratosis by 50%.

RESOURCES:

American Academy of Dermatology
http://www.aad.org

American Osteopathic College of Dermatology
http://www.aocd.org

CANADIAN RESOURCES:

BC Cancer Agency
http://www.bccancer.bc.ca

BC Health Guide
http://www.bchealthguide.org

References:

Actinic keratosis. DynaMed website. Available at: http://www.dynamicmedical.com/dynamed.nsf?opendatabase . Accessed August 11, 2005.

Actinic keratosis: what you should know about this common precancer. The Skin Cancer Foundation website. Available at: http://www.skincancer.org/ak/index.php . Accessed December 11, 2006.

Actinic keratosis: what you should know about this common precancer. The Skin Cancer Foundation website. Available at: http://www.skincancer.org/ak/index.php . Accessed August 11, 2005.

Chronic effects of sunlight. In: The Merck Manual . 17th ed. West Point, PA: Merck and Co.; 1999.

Jeffes EW III, Tang, EH. Actinic keratosis. Current treatment options. Am J Clin Dermatol . 2000;1:167.

Rivers JK, Arlette J, Shear N, et al. Topical treatment of actinic keratoses with 3.0% diclofenac in 2.5% hyaluronan gel. Br J Dermatol . 2002;146:94.

Stockfleth E, Meyer T, Benninghoff B, Christophers E. Successful treatment of actinic keratosis with imiquimod cream 5%: a report of six cases. Br J Dermatol . 2001;144:1050.



Last reviewed January 2008 by Ross Zeltser, MD

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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