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Actinic Keratosis

What is it?

Actinic Keratoses are lesions that develop raised spots or plaques that result from the middle layers of the epidermis (outer layer of skin) and often show up in sun-exposed areas, such as the head, neck, trunk and extremities. 

Are these lesions dangerous?

Actinic Keratoses are lesions of concern, as they are considered to be pre-cancerous. They are precursors to Squamous Cell Carcinomas (SCC).

Although most actinic keratosis spots do not turn into SCC, a lot of SCCs develop from pre-existing actinic keratosis spots. Currently, there is no reliable clinical measure to determine which actinic keratosis spots turn into SCC and which don’t. It is estimated that around 0.03-20% of actinic keratoses turn into SCC.

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What do these lesions look like?

Actinic Keratosis typically develops as solitary or multiple lesions in areas of the body with high sun exposure. Classically, these lesions present as scaly raised papules or plaques.

Sometimes, these lesions can look like smooth red outgrowths in the skin or have projections that look like horns growing from the center of the lesion. Lastly, these lesions can sometimes present as pigmented scaly patches that can be greater than 1.5 cm.

Actinic Keratosis Pictures

What causes this?

The development of actinic keratosis depends on the extent of sun exposure and patient specific characteristics, such as gender, age and geographic location.

It has been found that actinic keratosis is more commonly found in men, the incidence increases with age and it is more common in areas where individuals have greater exposure to ultraviolet light early in life.

What is the treatment for this?

There are different ways of treating actinic keratosis spots. Some individuals may choose to monitor the lesion as the lesions can stay the same or spontaneously resolve.

Management ranges from the use of prescription destructive creams such as imiquimod and topical 5-FU., cryotherapy, electrodessication and surgical excision if there is high suspicion that the lesions have turned into an SCC. Often complete excision of the lesion in aesthetically sensitive areas can help achieve the best results.

It is recommended that the lesion be biopsied if one of the following applies:

  • The lesions are growing quickly.

  • They are greater than 1 cm in size.

  • They become ulcerated.

  • There is tenderness.

  • There is an underlying induration (hardening) beneath the lesion.

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What happens after I have the lesion excised?

After the lesion is excised and closed with either permanent or dissolving sutures, the specimen is sent to a pathologist who examines it under the microscope to confirm the diagnosis and to ensure that the lesion is completely excised.

5-7, if the lesion was on your face, or 10-14 days, if the lesion was on body parts other than the face, or, after your surgery, you come back to the office/clinic to review the pathology report, to check on your incision and to remove or trim your sutures.

I have actinic keratosis, now what?

Actinic Keratosis is often an indication of sun damage. If an individual has multiple actinic keratosis spots and/or previous skin cancers, it is important that yearly skin exams are scheduled with a physician to monitor for new lesions. Additionally, protection from further sun damage is also very important. The use of hats and clothing that cover exposed skin, as well as sunblock is vital to prevent the development of further skin cancers.

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