An actinic keratosis (AK) is a sun-damaged spot that has a low risk for turning into skin cancer, specifically squamous cell carcinoma. It is usually fixed in location and rough or scaly to the touch. The face is the most common site, but the sides of the neck, the arms, and the balding scalp may also be affected. An AK often hurts or stings because the sun has damaged the skin so much that the nerves are less protected and can get inflamed.
The sun!!! And it is usually more recent sun exposure, say in the last 12-24 months. Sun exposure any time in life predisposes to skin cancer. But the presence and number of actinic keratoses correlates best with recent sun exposure.
If you have actinic keratoses, you need to wear sunscreen every day! Don't fall into the trap of thinking, "I'll only wear sunscreen on days that I know I will be spending time outdoors." My experience has been that invariably patients will find themselves outside for 5, 10, or 30 minutes talking with a neighbor, strolling in an outdoor mall, etc. Five minutes here, ten there adds up over time. So put on sunscreen every morning--at least SPF 30. And don't just protect the face. Protect your hands, arms, neck and chest (legs too?)
SPF stands for sun protection factor and is a measure of the strength of the sunscreen. I recommend a daily morning SPF of at least 30. If you know you will be outdoors for 30 minutes or more, then I recommend an SPF 50. Remember that most people don't put enough sunscreen on, so slather that stuff on the skin!!
Some patients reply, "But I wear a hat!" Given the choice between a hat and sunscreen, I would pick the sunscreen. The trouble is that most of the UV that hits our skin does not come directly from the sun. Instead, it is scattered by the blue sky or reflected off the ground, sand, or concrete. Thus, even when in the shade, your skin may be getting damaging UV rays. Why not use both a hat and sunscreen!
Yes! It turns out that good, scientific studies have shown that taking oral nicotinamide 500 mg twice a day can reduce both the number of current actinic keratoses and the development of new ones. (Don't confuse nicotinamide with niacin or nicotinic acid.) Nicotinamide is an over-the-counter form of Vitamin B3. It has very few side effects (in contrast to niacin) and has very few drug interactions.
The area may be swollen and red for the first day or so. It may even blister. (Large blisters may be popped with a sterile needle.) You may cover the area with a bandage, vaseline, or makeup with no problem. Within several days, the area will scab. In 7-14 days, the scab will fall off leaving smooth, normal, pink skin. If the area is still rough three weeks after freezing, let your doctor know.
Any patient with AKs is at higher risk for various skin cancers including basal cell carcinoma, squamous cell carcinoma and melanoma. A melanoma is of course the most serious and often appears as an asymmetric, irregular mole with multiple colors. A monthly skin self examination is recommended. Things to watch out for are:
If you have any concerns, see your dermatologist.
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