Precancers (Actinic Keratoses)
What is an actinic keratosis?
AKs are a skin condition caused by chronic sun damage. It causes scaly, rough, or bumpy spots on the skin that can appear red or brown. AKs are not cancer but can sometimes change into squamous cell skin cancer, which is the second most common form of skin cancer, so they are important to treat. Having one or more painful sunburns in your life raises your risk of getting AKs.
AKs are most common in people who:
- Spend a lot of time outside (or did when you were younger).
- Have fair (light) skin and hair, and/or freckles.
- Sunburn easily.
Common places for AKs include sun-exposed areas, which include the:
- Tops of ears.
- Backs of the hands and forearms.
- Legs or feet, especially in women
What do AKs look like?
- Flattish and rough (sandpaper-like feel).
- Red (most often), skin-colored or brown.
- Thick, crusty, or scaly.
- Smooth and red.
- AK’s on the lip (actinic cheilitis) will cause a rough, dry, or scaly spot that might crack or have a sore.
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How are AKs treated?
Most commonly, they are frozen off with liquid nitrogen (“cryotherapy”) to prevent them from turning into a squamous cell skin cancer.
While Cryotherapy is the gold standard for spot treatments of AKs, there are several global treatments that are also available. These treatments include photodynamic therapy (Blu-Light), topical chemotherapy creams, and chemical peels. Each of these treatments cause local destruction of the premalignant cells, which allows the skin to regenerate with new, healthy cells. These treatments utilize different mechanisms to destroy precancerous lesions, so there are different risks and benefits associated with each treatment. Our providers can discuss the specifics of each treatment and determine a plan that is ideal for your health.
Expect some redness, swelling and irritation for around 7-10 days after treatment. Sometimes a blister will form. Thicker or larger lesions may take longer to heal. After 2 weeks, some red or pink may remain, but the spot of skin that was treated should feel smooth. If there is still some roughness or redness, the spot should be retreated. Although most AKs only require one treatment, some may require 2-3 treatments. No special care is required after treatment. You can wash your skin with a gentle cleanser and apply your face products and sunscreens as normal. If you use harsh products, such as benzoyl peroxide, glycolic acid, salicylic acid, or tretinoin (Retin-A), the treated spots may be irritated for longer.
If you are scheduled for a Blu-Light treatment, you should expect to be in the office for about 2 to 3 hours. When you arrive, a medical assistant will room you, take some photos of the area to be treated, and will degrease your skin with isopropyl alcohol and acetone. After your skin has been prepped, the doctor or physician assistant will apply a photosensitive gel to the area. This gel will then have to incubate and absorb into your skin for two hours, during which, you can relax in our waiting room. After the two-hour incubation period, you will be brought back to the room, positioned under the Blu-Light, and given protective eyewear. The Blu-Light will illuminate the area treated for 16 minutes and 40 seconds. This illumination activates the photosensitive gel which initiates the destruction process. It is normal to feel a burning sensation during this process. You will be given a fan and ice to help manage discomfort. After the treatment is complete, sunscreen will be applied. It is recommended that you also bring a hat if your face and/or scalp is treated.
For one week post-treatment, it is advised that you use strict sun protection including daily sunscreen, hats/long sleeves/pants, and avoiding the sun when possible. The area treated will be red, swollen, and irritated, and may peel for up to two weeks. Only gentle moisturizers and cleansers should be used until the skin heals. Your provider may want to see you for follow-up approximately six weeks post-treatment to assess your results and touch-up any persistent lesions with cryotherapy. While Blu-Light treatment is often covered through your insurance, a prior authorization may be necessary. Cash prices are also available.
There are several topical chemotherapies that your provider can prescribe including 5-fluorouracil (Efudex) and imiquimod. These medicated creams are often covered by insurance, but their out-of-pocket cost can still be high depending on your insurance. The duration and frequency with which your provider recommends you apply the cream may vary depending on the severity of your lesions, but the average treatment times range from 2-6 weeks, either once or twice a day. During your treatment, you will experience redness, irritation, tenderness, and peeling. These symptoms will likely last for 1-2 weeks post treatment but will gradually fade. It is imperative that strict sun protection is utilized during and in the weeks following treatment. Your provider may want to see you for follow-up to assess your results.
Chemical peels are another great option for the destruction of AKs. Mostly commonly, either 25% or 35% Trichloroacetic Acid (TCA) is used. Prior to the peel, photos will be taken, and you will be numbed with a topical numbing cream. Your skin will then be degreased with isopropyl alcohol and acetone. The provider will then apply a layer of the TCA to your skin. It is common to experience some burning while the peel is being applied. This sensation usually subsides within minutes, and cool gauze and a fan will be used to manage your discomfort. After the treatment, sunscreen will be applied. For 1-2 weeks post-procedure your skin will be red and will peel. Using strict sun protection during this time will be important to protect your skin and maintain your results. A TCA peel for the treatment of AKs is usually covered by insurance, but a prior authorization may be necessary.
Yes, protect your skin and lower your chance by:
Staying out of the sun, especially at the highest times of UV exposure (10 a.m. to 4 p.m.).
Wearing a broad-spectrum sunscreen. An SPF of 50 is best, but an SPF of at least 30 is recommended.
Reapplying sunscreen every 2 hours to exposed areas of skin.
Wearing a wide-brimmed hat, long-sleeved shirt, long pants, or long skirt outside.
DO NOT use tanning beds.
Since there are multiple treatments for AKs, our providers consider each patient individually to develop a treatment plant that is most suitable.
Please contact CLEAR Dermatology and Aesthetics Center if you would like to be checked for precancers.