Actinic Keratoses (AK) Overview
Actinic keratoses (AKs) are considered the earliest stage in the development of skin cancer. They are common lesions of the outermost layer of the skin (epidermis) from long-term exposure to sunlight. AKs usually appear after age 40. Those who were born and raised in high-intensity sunlight states such as Florida, AKs may be found on younger adults.
The most significant predisposing factor to AKs is fair skin and a long history of sun exposure without protection. Chronic sun exposure causes skin cells to change size, shape, and the way they are organized. The skin cells affected in AKs are the keratinocytes. Keratinocytes are the tough-walled cells that make up 90 percent of the epidermis and give the skin its texture.
Actinic keratoses (AK), also called solar keratoses, are scaly, crusty growths (lesions) caused by damage from the sun’s ultraviolet (UV) rays. They typically appear on sun-exposed areas such as the face, bald scalp, lips, and the back of the hands, and are often elevated, rough in texture, and resemble warts. Most become red, but some will be tan, pink, and/or flesh-toned. If left untreated, up to ten percent of AKs develop into squamous cell carcinoma (SCC), the second most common form of skin cancer.
Actinic Keratoses Causes
Repeated, prolonged sun exposure causes skin damage, especially in fair-skinned persons. Sun-damaged skin becomes dry and wrinkled and may form rough, scaly spots called actinic keratoses. These rough spots remain on the skin even though the crust or scale is picked off. Treatment of an actinic keratosis requires removal of the defective skin cells. New skin then forms from the deeper skin cells, which have escaped sun damage.
Actinic Keratoses Treatments
Actinic keratoses are not skin cancers. Because they sometimes may turn cancerous, it is usually a good idea to remove them. In persons with many actinic keratoses, only those that show change, bleed, or are enlarging need to be removed.
Actinic keratoses can be removed surgically with scissors or a scraping instrument called a curette. Another way of destroying actinic keratoses is to freeze them with liquid nitrogen. Freezing causes blistering and shedding of the sun- damaged skin. Sometimes, we are not sure whether the growth is harmless. when there’s doubt, I prefer to cut the growth off and send it for microscopic analysis (biopsy). Healing after removal usually takes 2 to 4 weeks, depending on the size and location of the keratosis. Hands and legs heal more slowly than the face. The skin’s final appearance is usually excellent.
When there are many keratoses, a useful treatment is the application of 5-fluorouracil (5-FU). The medication is rubbed on the keratoses for 15 to 25 days.
5-FU destroys sun-damaged skin cells. After 3 to 5 days, the treated area starts to get raw. The applications are continued until your physician determines that you have obtained the needed results. Healing starts when the 5-FU is stopped. 5-FU is effective in removing actinic keratoses from the face, but it often fails when used on the hands, forearms, or back.
Actinic Keratoses Prevention
Sun damage is permanent. Once sun damage has progressed to the point where actinic keratoses develop, new keratoses may appear even without further sun exposure. You should avoid excessive sun exposure-but don’t go overboard and deprive yourself of the pleasure of being outdoors. Reasonable sun protection should be your aim.