Actinic keratoses are lesions that are known as the early beginnings of skin cancer as they have the potential to progress into invasive squamous cell carcinoma. Early recognition is an important factor in successful treatment. Key to early recognition is a patient who is well informed and a physician who provides relevant counseling.

Actinic keratoses (AKs) are preventable and highly treatable skin lesions resulting from damage to the skin by ultraviolet radiation. Prevention requires recognition of risk for AKs and knowledge of measures to reduce risk. Effective therapy requires early recognition, diagnosis and treatment before the lesion becomes large and unsightly and before malignant transformation of the lesion occurs.

Early recognition and treatment are facilitated when the patient at risk for AKs is well informed and the physician provides specific counseling or treatment recommendations based upon the patient’s history and comprehensive skin examination. Among physicians, dermatologists are best equipped by training and experience to counsel the patient and provide effective treatment.

Data generated from analysis of more than 700 million office visits to physicians in a given year show that dermatologists are most likely to provide effective AK and skin cancer prevention counseling based upon skin examination and medical history. [Reference: Feldman SR, Fleischer AB Jr. Skin examinations and skin cancer prevention counseling by U.S. physicians: a long way to go. J Am Acad Dermatol 2000; 43:234-237].

A person at risk for AKs should see a dermatologist regularly for skin examinations and specific counseling based upon the skin examinations and personal and family medical history. High risk for AKs can justify referral of a patient to a dermatologist by a primary care physician or a physician in another medical specialty.

Factors that increase risk for actinic keratoses

• Age—40 or older
• Color of skin—pale white to creamy white
• Color of eyes—blue, gray, hazel, green
• Color of hair—red or blond
• Ancestry—Celtic (Irish, Scottish, Welsh, Breton)

Sun exposure habits—golf, gardening, farming, fishing, hiking, sunbathing, outdoor swimming, etc.

(Read What Increases Your Risk? and What are Actinic Keratoses?)

AKs can be said to have a genetic basis because skin-hair-eye color are inheritable risk factors that make a person more susceptible to ultraviolet damage to the skin. In general, the fairer, less pigmented the skin, the greater the risk for AKs, photoaging and skin cancer. The Food and Drug Administration (FDA) and the American Academy of Dermatology recognize six skin characteristics related to skin and ultraviolet radiation:

What the dermatologist or other physician should know about you, in addition to your risk factors for AKs

• Medical history—especially any previously treated AKs or skin cancers
• Family history—especially any skin cancer in the family
• Sun exposure habits—occupational, recreational
• Sun protection habits—is there regular use of sunscreen and protective clothing, staying out of the sun at peak hours of sun intensity?

Any skin lesions that recently appeared or you recently noticed

• When did the lesion first appear?
• Does it itch, burn or hurt?
• Any noticeable changes in the lesion’s color or shape?

• Is there anything that appears to make the lesion worse?

The American Academy of Dermatology recommends that everyone practice regular skin self-examinations for any changes in the skin. If any growth, mole, sore or skin discoloration appears suddenly or begins to change, see your dermatologist.

Assessment of the skin’s texture, color, temperature and moisture can also reveal information about your general health.

Physician counseling based upon personal and family history, physical examination, and skin examination can be helpful in preventing premalignant lesions and skin cancer. Counseling can teach the patient how to self-examine for suspicious lesions.  An illustrated guide that shows how to self examine your skin is found at Self Examination for Melanoma.  While this guide focuses on melanoma and how to examine moles, this same process can be used to identify other changes to the skin.

The well-informed patient is a person most likely to seek medical advice based upon knowledge of risk factors and/or self-examination for a premalignant or malignant skin disease. The well-informed patient also is a person most likely to seek relevant advice and examination from a dermatologist—the medical specialist most qualified to provide that service.