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