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Actinic Keratoses (AK)

Actinic Keratoses (AK) are growths seen on the skin, commonly after many years of sun exposure. They are mostly seen in fair skinned and light eyed individuals, usually starting at 30-40 years of age. In actinic keratosis, keratinocytes (the cells that make up the skin) become damaged and are considered to be in a pre-cancerous state. It is important to be able to identify actinic keratosis because they have the potential to become a type of skin cancer known as Squamous Cell Carcinoma (SCC).

Actinic Keratosis commonly affects areas exposed to the sun such as the face, scalp, neck and forearms, but may occur anywhere on the body exposed to sun. They appear as 1-4mm red to brown spots that do not go away. They often have a rough and gritty texture and are often easier felt than seen. The skin surrounding the spots might appear red and irritated. These spots may sting, itch or bleed upon scratching. One cannot predict which AKs progress to SCC, but lesions on the lips and ears have a higher likelihood of progression. It is important to see a healthcare professional for proper treatment to prevent further cell damage and progression to SCC.

Sun avoidance is the most important factor in preventing the formation and progression of lesions. Sunscreen should be frequently applied to sun exposed skin. Patients should also examine their own skin regularly and take note of new or changing spots.

Treatment is usually well tolerated and effective and is either through surgery or topical medicine applied to the skin. Some of the treatment options available are:

  1. Cryotherapy - Involves freezing the growths with liquid nitrogen which kills the damaged cell. This procedure is quick, but is mildly painful. The growth tends to blister over and heal within 7-10 days leaving minimal scarring. Affected skin might appear lighter in some patients.
  2. 5- Fluoruracil - Topical cream applied twice daily for one month. With this treatment the spots can get very red and inflamed. Patients frequently have discomfort over the redness and irritation of their face. However, after stopping treatment their complexion improves and their skin is healed.
  3. Aldara (Imiquimod cream) - Cream is applied 2-3 times weekly for one month. It works by activating the body's own immune system to kill the abnormal cells. Skin might appear very red and irritated during treatment in some patients.
  4. Surgery - Using local anesthetic, spots may be scraped, shaved or excised. This allows for a sample to be sent for microscopic evaluation. The surgical site will require time to heal and may leave a scar.