ActinicKeratosesNet Article
What Every Patient with Actinic Keratoses (AKs) Should Know

If you have actinic keratoses (AKs), here are three key facts you should know:

• AKs are the earliest stage in the development of skin cancer.
   

• AKs develop in skin damaged by ultraviolet (UV) radiation, so it is essential to protect your skin from the sun as well as avoid tanning beds and other tanning devices.
   

• Studies show that between .025% and 16% of AKs per year progress to squamous cell carcinoma (SCC), a type of skin cancer that can spread.

What’s Your Risk of Developing Squamous Cell Carcinoma?
You may not think it likely that you will develop SCC since the risk ranges from .025% to 16%. The truth is having AKs places you in a high-risk group for developing SCC. This range — from .025% to 16% — estimates the risk that one AK will turn into SCC. Most people develop multiple AKs, so the risk increases.

Other factors that increase your risk of an AK progressing to SCC include advancing age, taking a medication or having a medical condition that suppresses your immune system, a personal or family history of skin cancer, and fair skin. If your skin shows signs of severe sun damage, this also increases your risk. Signs of sun damage, also known as photodamage, include age spots, spider veins on the face, rough and leathery skin, fine wrinkles that disappear when stretched, loose skin, and a blotchy complexion.

How an AK Becomes Squamous Cell Carcinoma
Both AKs and SCC are caused by exposure to ultraviolet (UV) radiation.

UV radiation is a known carcinogen (cancer-causing agent). Each time we expose our skin to UV radiation — whether from the sun, a tanning bed, or sun lamp — cells in our skin are damaged. The body works hard to repair this damage. Worn out and damaged cells are destroyed through a carefully regulated process in our bodies called apoptosis or programmed cell death.

A key player in apoptosis is a gene named p53, which works to suppress tumors in the human body. Our first exposure to UV rays causes the first mutation to p53. With repeat UV exposure, p53 continues to mutate. Eventually, the ongoing p53 mutations cause the carefully regulated process of apoptosis to go awry. The body cannot suppress tumors, and abnormal cells divide uncontrollably instead of dying. When these abnormal cells grow on the top layer of the skin, an AK forms.

Without treatment and protection from UV rays, the cells can continue to grow uncontrollably. If these abnormal cells penetrate the middle layers of the skin, the AK becomes a SCC.

Treatment, Sun Protection, and a Watchful Eye Required
There is currently no way to predict which AKs will progress to SCC, so dermatologists recommend that everyone diagnosed with AKs:

• Seek treatment

• Practice sun protection

• Get screened regularly by a dermatologist and perform regular self-exams

Seek treatment. Dermatologists stress that patients should have their AKs treated. Treatment can prevent AKs from progressing as well as help patients avoid more costly and invasive treatment later. If SCC develops, treatment can be disfiguring. In rare cases, the cancer spreads and causes the person’s death.

Patients with multiple AKs should know that all AKs may not be treated at the same time. Before treating the lesions, a dermatologist considers a number of factors, including the size and location of the AKs as well as the patient’s preference. Sometimes more than one treatment option is appropriate. The treatments may be performed at different times.

Practice sun protection. Research shows that protecting your skin from the sun’s harmful UV rays can be beneficial even when you have AKs. Sun protection can prevent further damage and allow the body to repair some of the existing damage.

Sun protection includes wearing protective clothing, such as a wide-brimmed hat, long pants, and long sleeves; applying a broad-spectrum sunscreen with an SPF of 30 or greater to all skin that will be exposed to the sun; seeking shade; and avoiding deliberate tanning.

It is essential that your sunscreen provide broad-spectrum protection. “Broad spectrum” means that the sunscreen contains ingredients that protect your skin from the sun’s UVA rays and UVB rays. UVA rays penetrate the skin more deeply than UVB rays and are the rays that contribute to premature aging and wrinkles. The UVB rays, also known as the burning rays, cause sunburn. Both UVA and UVB rays have been linked to the development of skin cancer. You can find out if a sunscreen is broad-spectrum by reading the label. Sometimes the label reads “broad spectrum”; sometimes it says “UVA and UVB protection.”

Sun protection should be practiced year round. While UV radiation is most intense during the summer months, more than 50% of UV radiation reaches us during the remaining months of the year when we usually do not think about sun protection.

Get screened regularly by a dermatologist and perform regular self-exams. If you have AKs, you should see a dermatologist regularly. Just as cardiologists are the heart specialists, dermatologists are the skin specialists. Dermatologists receive extensive, specialized training in the detection and treatment of AKs, SCC, and thousands of other skin conditions. Studies show that dermatologists more accurately diagnose skin cancers than any other medical doctor.

Regular self-examinations of your skin are equally important. Your goal is to detect as early as possible: 1) a new lesion and 2) a change to an existing lesion. A lesion is “changing” if the size or appearance changes or the lesion bleeds or itches. Your dermatologist should examine any new or changing lesion. If you have never examined your skin and do not know how to perform a self-examination, ask a dermatologist to instruct you.

Early Detection Increases Cure Rate for Skin Cancer
Working together as a team, you and your dermatologist can spot suspicious lesions in the earliest stages. This is extremely important if you have AKs because AKs are a sign of sun damage. Sun-damaged skin increases your risk of developing SCC and other skin cancers, including melanoma. With early detection and proper treatment, skin cancer is curable. The average cure rate with early detection and treatment is 95%. Even melanoma, the most deadly form of skin cancer, when limited to the outermost layers of the skin yields a 95% cure rate.

References:
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Cockerell CJ. “Histopathology of incipient intraepidermal squamous cell carcinoma (“actinic keratosis”).” Journal of the American Academy of Dermatology. 2000 January;42(1 Pt 2):S11-S17.

Dinehart SM. “The treatment of actinic keratoses.” Journal of the American Academy of Dermatology. 2000 January;42(1 Pt 2):S25-S28.

Glogau RG. “The risk of progression to invasive disease.” Journal of the American Academy of Dermatology. 2000 January;42(1 Pt 2):S23-S24.

Leffell DJ. “The scientific basis of skin cancer.” Journal of the American Academy of Dermatology. 2000 January;42(1 Pt 2):S18-S22.

Moy RL. “Clinical presentation of actinic keratoses and squamous cell carcinoma.” Journal of the American Academy of Dermatology. 2000 January;42(1 Pt 2):S8-S10.

Ortonne JP. “From actinic keratoses to squamous cell carcinoma.” British Journal of Dermatology. 2002 April;146(s61):20-23.

Salasche SJ. “Epidemiology of actinic keratoses and squamous cell carcinoma.” Journal of the American Academy of Dermatology. 2000 January;42(1 Pt 2):S4-S7.