Actinic Keratosis

What are Actinic Keratosis?

Actinic Keratosis (AKs) are one of the most common skin lesions seen in on sundamaged skin. They are caused by cumulative exposure to ultraviolet radiation. AKs are also referred to by the term "solar keratosis."

Fig 1. Actinic Keratosis on the hands
 

Fig 2. Ultraviolet Spectrum

Why are Actinic Keratosis worrisome?

AKs are thought to be, by many, the earliest form of premalignancy. AKs usually begin in the third and fourth decade, and, in six to ten per cent of cases evolve to become an invasive malignancy. Individuals who are fair skinned, have blue eyes or red or blond hair, or are outdoors much of the time are particularly susceptible to Squamous Cell Carcinoma development.

What do Actinic Keratosis look like on the skin?

Actinic keratosis are categorized into four types of lesions:
  
Fig 3.Actinic Keratosis, pigmented subtype

TABLE 1.

Actinic Keratosis can be either inflamed, rough, or scaling lesions. Often patients note that they "come and go in the same location", are easily palpable, and have  some type of discomfort, whether it be itching, tingling or burning.

Where do Actinic Keratosis form and where are they most dangerous?

Actinic Keratosis can form anywhere on the body. They usually form in sun exposed areas, face, scalp, hands. They are most dangerous when they form over the lip or ear regions, as these areas are more susceptible to invasive cancer formation. If you notice recurrent AKs forming on your skin, you should follow-up with us for a skin biopsy.

Fig 4. AKs on lower lip (Actinic Cheilitis)

What are some of the treatments available for Actinic Keratosis?

We often utilize a liquid nitrogen spray to treat AKs. This causes a slight blistering effect on the skin, and through causing inflammation will rid the skin of  the actinic keratosis. On the lip or ear area (areas of high risk), the best treatment utilizes a carbon dioxide (CO₂) laser.

This allows even healing and evaporation of the low grade precancerous state. Finally, for those patients with a multitude of lesions (where the number of AKs makes either carbon dioxide resurfacing or liquid nitrogen a poor choice),  5-fluorouracil cream (5 FU), a common anticancer medication is used. 5FU is applied topically to the skin for two weeks and during this time causes intense inflammation on the skin. Over the next two weeks, a healing cream is applied to the skin.  Another new medication called imiquimod or Aldara^® has also been used to treat these growths
  
Fig 5. Actinic Keratosis (under the microscope). 
 

SUMMARY

In summary, Actinic Keratosis are thought to be early premalignant skin growths. They can develop into skin cancer in about 6 to 10 % of the time.

If you have any questions, or wish to schedule a consultation, please call  Ponte Vedra Dermatology & Aesthetic Surgery at (904) 285-7546 or email consultation@pvderm.com