Actinic keratoses: Diagnosis and treatment

A pre-cancer is just what the name implies: it is not yet a cancer, but if left untreated, it may develop into a skin cancer. In truth, only a small percentage of actinic keratoses may go on to develop into actual skin cancers, and the process may take years. However, if left alone, they may develop into squamous cell carcinomas that do have a small potential for spread through the body. Early detection and treatment of AKs can prevent this from happening.  A board-certified dermatologist can diagnose actinic keratoses looking at your skin.  If needed, a skin biopsy can be done to confirm the diagnosis; however, this is typically not necessary. 

Fortunately, treatment of actinic keratoses is relatively straightforward. Dr. Jogi may discuss the following options with you: 
  • Cryosurgery: Freezing an actinic keratosis with liquid nitrogen can cause the lesion to slough off and disappear. This is a relatively easy, quick procedure with little downtime, and it is the most common method of treatment; however, the treated spots may appear red for about a week or two. 
  • Surgical removal: If hypertrophic (relatively large and raised off the skin), your doctor may elect to remove the actinic keratosis via shave biopsy. This is done commonly for cutaneous horns. 
  • Topical 5-fluorouracil (5-FU, Efudex, Carac): These medications are cream versions of a chemotherapy medication. Creams containing this ingredient cause the actinic keratoses to become red and inflamed before they fall off. The treatment is quite effective; however, during treatment, the medication can produce an uncomfortable and unsightly appearance to the skin, making it difficult for some patients to tolerate. It is good for areas that have a large amount of sun damage and many actinic keratoses to help make the skin much smoother and even-toned with fewer precancerous lesions. 
  • Topical imiquimod (Aldara, Zyclara): These medications are immune stimulators that have similar indications and outcomes as topical 5-FU. 
  • Topical diclofenac (Solaraze): This gel is a topical non-steroidal anti-inflammatory drug that is much gentler than 5-FU and imiquimod. However, it must be applied twice daily for a much longer interval (as long as 2-3 months) to have the same effect. 
  • Topical ingenol mebutate (Picato): This is a plant-derived substance that induces cell death.  Its advantage is that dosing is very rapid, with topical application over 2-3 days.  A very brisk inflammatory response is typically seen, but treatment is complete by about 10 days. 
  • Photodynamic therapy (PDT): This treatment involved pretreating the skin with a dye (aminolevulinic acid) that sensitizes the skin to light. The dye is left on for 1-2 hours, and the skin is then treated with a laser or other light source that activates the dye and treats the precancers. It works best for patients with many AKs, particularly because of the amount of time involved with the procedure. Patients often need to avoid sun exposure or exposure to intense fluorescent light for two days following the treatments. 
  • Fraxel: Fraxel is a non-ablative laser used for the treatment of actinic keratoses.  The 1927 thulium fiber laser allows resurfacing of the skin with only a few days of downtime.  The procedure is quick and effective, with an approximately 85% reduction in the number of lesions.  Insurance typically does not cover this procedure.

Really, as is the case for many diseases, prevention is the best treatment. While you can’t undo the UV exposure that you’ve already gotten, you can definitely keep your skin from getting any worse. It’s important to follow sun safety measures on a regular basis and to start right away. 

If you think you may have actinic keratoses or other suspicious skin lesions it is best to seek the opinion of a dermatologist. If you would like Dr. Reena Jogi to evaluate your skin, please call 713.487.5644 to schedule a consultation, or click here to register online as a new patient.