Treatment

Actinic keratoses (AKs) are so common today that treatment for these lesions ranks as one of the most frequent reasons that people consult a dermatologist.

Often patients want these lesions removed for cosmetic purposes since AKs tend to occur in highly visible places, such as the hands, arms, face, and neck. Whether or not cosmetic concerns are a motivating factor, it is extremely important to consult a dermatologist or dermatologic surgeon when an actinic keratosis (AK) lesion is suspected. Left untreated, AKs have the potential to progress to squamous cell carcinoma, a form of skin cancer that can be life threatening.

Diagnosis
AKs have unique physical characteristics that allow dermatologists to visually identify these lesions. However, if an AK is especially large or thick, the lesion may be surgically removed for microscopic examination (biopsy) to determine if squamous cell carcinoma is present.

When an AK is diagnosed, dermatologists consider a number of factors before choosing the most appropriate treatment method. Factors include:

• Size, number, location, and stage of the lesions

• Age, health, and medical history

• Occupation

• Cosmetic expectations and treatment preferences

• Patient compliance (i.e., willingness to self-treat as needed for several weeks)

• History of previous treatment

How AKs are Treated
There are several treatment options for AKs, including cryosurgery (freezing), surgical excision, curettage (scraping) with or without electrosurgery (heat generated by an electric current) and topical (applied to the skin) medications. Lasers, chemical peels, dermabrasion, and photodynamic therapy may also be used.

Patients who have multiple AKs may not have all lesions treated at the same time, and in some cases, the dermatologist or dermatologic surgeon will use more than one treatment option.

For information about specific treatments used to treat AKs, visit Treatment Options.

What to Expect After Treatment
Practice Sun Safety. Sun safety practices are a medical necessity in order to prevent new AKs and squamous cell carcinoma from developing. After treatment, patients routinely receive guidelines for practicing sun safety.

Sun safety practices include:

• Avoid excessive exposure to sunlight. Stay out of direct sun exposure during peak (10a.m. — 4p.m.) sunlight hours.

• Use a broad-spectrum sunscreen with a SPF of 15 or higher. Broad-spectrum sunscreen provides protection from both the UVA and UVB rays of the sun. Apply broad-spectrum sunscreen at least
  15 to 30 minutes before going outdoors, even on cloudy days.

• Reapply sunscreen every two hours. When outdoors and even on cloudy days, be sure to reapply sunscreen every two hours.

• Wear protective clothing. When outdoors during daylight, wear a wide-brimmed hat, sunglasses that block 100% of the UV rays and tightly knit clothing that covers arms and legs.

Topical Retinoids. In addition to sun-protection practices, topical (applied to the skin) retinoids (vitamin A derivatives) may be prescribed. Topical retinoids are not suitable for every patient, but may be prescribed in some cases to help prevent new AKs from developing.

Re-examination. Dermatologists and dermatologic surgeons regularly
re-examine patients treated for AKs. Frequency depends on the extent of the AKs, sun-damaged skin, and the treatment method. Re-examination may be as frequent as every 8 to 12 weeks or require only 1 to 2 visits per year. It is extremely important to keep these re-examination appointments because when enough sun damage occurs to cause AKs, the possibility of developing more AKs or even skin cancer greatly increases.

Re-treatment. Re-treatment is sometimes necessary as new AKs can develop and occasionally AKs recur. Whenever a lesion is spotted, be sure to consult a dermatologist or dermatologic surgeon because left untreated, AKs have the potential to progress to squamous cell carcinoma.

An educational program brought to you by the American Academy of Dermatology.