Actinic keratosis is considered to be pre-cancerous skin lesions that appear as scaly, crusty, and thick patches. If pre-cancerous actinic keratosis lesions are not treated, there is a possibility it may develop into squamous cell carcinoma, an aggressive skin cancer. Development of actinic keratosis occurs when skin is exposed to the sun (or tanning beds) over an extended period of time, especially in fair-skinned/hair (lower melanin count), freckled, and easily sunburned, as well as in balding individuals.
The most important cause of AK formation is solar radiation, specifically UV-B radiation. UV-B radiation may induce mutations in the keratinocytes of the epidermis, generating significant and erratic cellular mutations where DNA is damaged. Damaged DNA may cause unchecked proliferation of keratinocytes thereby serving as a source of neoplastic or carcinogenic cells. Recent research suggests that the human papillomavirus (HPV) may also play a role in the development of AKs. Similar to UV radiation, higher levels of HPV found in AKs reflect enhanced viral DNA replication; this is suspected to be related to the abnormal keratinocyte proliferation and differentiation in AKs which provide a communalistic environment for HPV replication.
Actinic keratosis lesions are asymptomatic yet may cause itching, bleeding, or burning sensation. The lesions tend to feel like a thick, scaly, and dry texture and may appear as being dark, light, tan, pink, red, or have the same color as the surrounding skin. The lesions usually are no more than a couple of millimeters in diameter. As mentioned, actinic keratosis is more likely to appear on sun-exposed areas of the skin, such as the face, ears, neck, scalp, chest, backs of hands, forearms, or lips. Cancerization is known to be a variety of lesions of varying size and severity observed on high surface skin areas of sun-exposed skin. These lesions are usually biopsied for the presence of carcinogenic cells.
We can diagnose actinic keratosis by examining the lesions during an office visit. Typically when the keratosis is large in diameter, thick, or bleeding, we will complete a biopsy to rule out the presence of skin cancer.
Due to the numerous variations of AK as well as depending on the patient and the clinical characteristics of the lesion there are many treatment options available for AK. A treatment plan may include one or more type of medicinal gels or creams. Photodynamic therapy, laser therapy, as well as cryotherapy through the use of liquid nitrogen are also available. Liquid nitrogen is the most commonly used destructive therapy for the treatment of AK. For more advanced cases of AK, surgery is possible. Surgical excision, shave excision, or dermabrasions are surgical techniques commonly used to treat AK’s. Although overall cure rates are high, experts agree that the best treatment for AK is prevention. Regular follow-up is advisable after any treatment to make sure no new lesions have developed, and that old lesions are not progressing.