Actinic keratoses are pre-cancerous lesions commonly found on the areas of the skin most often exposed to the sun such as the hands, face, arms, neck, scalp, ears and lips. They are common and present as slow-growing, scaly, rough sandpaper-like bumps. They come in shades or red, brown or pink and may itch or burn, though they don’t usually hurt. Other than this, there are no signs or symptoms.
Over time a subset of actinic keratoses can turn into a type of skin cancer called squamous cell carcinoma. Because of this, it is wise to have them checked from time to time by a dermatologist, especially if the bump changes. People should be suspicious if the keratosis grows, doesn’t go away after a time,starts to bleed or becomes painful.
A dermatologist can usually see whether an actinic keratosis needs to be treated by looking at it. If they’re still unsure, they might perform a biopsy. Dr. Krathen may remove a tiny bit of the lesion and sends it to the lab for analysis.
There are also several ways to physically remove actinic keratoses. One way is through cryotherapy. This procedure freezes the lesion with liquid nitrogen and kills it. The liquid nitrogen is applied by a probe or is sprayed on.
Eventually, the lesion falls off and is replaced by new, healthy skin. Most people who have actinic keratoses use cryotherapy to treat them, though the side effects include blistering, uneven skin texture and skin tone and scarring. Sometimes cryotherapy is used with the topical therapies described below.
Another way to remove an actinic keratosis is through curettage, which is done under a local anesthesia. During curettage, Dr. Krathen scrapes away the lesion with an instrument called a curette. After the layers of the actinic keratosis are scraped off, Dr. Krathen uses an electrical current to destroy whatever is left of the lesion.
Actinic keratoses do not necessarily need to be surgically removed. They can be treated by the application of gels and creams such as fluorouracil, imiquimod, ingenol mebutate or diclofenac. These topical applications are most effective if there are several closely spaced lesions on the skin. While effective, topical (at-home) treatment often causes significant redness and skin discomfort. Additionally, at-home topical treatment can take days to weeks to complete.
Other patients have their lesions removed through medium or deep chemical peels.These peels, where the skin is painted with a type of fruit acid or chemical solution, remove the top layers of skin and so remove or destroy the actinic keratosis. Lastly, skin resurfacing with a carbon dioxide laser can eradicate actinic keratoses as well as provide cosmetic rejuvenation and reduction in fine lines/wrinkles.
A consultation with Dr. Krathen can help you determine the best treatment plan for your unique circumstances.