Actinic keratosis, a pre-skin cancer!
What is Actinic Keratosis?
Actinic keratosis (AK, also known as solar keratosis ) is a very common skin lesion that results from the overgrowth of atypical superficial skin cells. Untreated AKs have the potential to progress to SCC (squamous cell carcinoma) which is a nonmelanoma skin cancer. Chronic sun exposure (especially for fair-skinned individuals) r is a major risk factor for the development of AKs.
Why AKs Detection and Treatment Are Important
Aks is known for pre skin cancer. Data suggests that 60% of skin SCCs (skin cancer) arise from AKs. Individuals with a history of AKs are at higher risk of developing SCC and BCC, the two most common types of skin cancer.
Appearance and location of AKs
AKs are often presented as a solitary or multiple nonhealing pinkish, rough, and scaly discoloration or bumps on the skin. AKs can have thick or thin surrounding tissue with a smooth reddish discoloration. AKs can be pigmented and become large, it is critical that they are differentiated from melanoma. Occasionally, AKs can have long horny dry surfaces. AKs are more likely to appear in sun-exposed areas such as the balding scalp, face, side of the neck, arm, and legs. On the face, AKs are frequently located on the lips in a condition called Actinic cheilitis.
Who is at high risk for AKs?
- Fair-skinned individuals since they have lower levels of skin melanin (color) that shields skin cells and protects them from the damaging effects of ultraviolet sun radiation
- Individuals with outdoor occupations (due to extensive sun exposure)
- Individuals with a history of sunburn
- Men are more likely to develop AKs than women
- Male individuals with balding scalp
- The older you are, the higher the risk for AKs due to the accumulative effect of sun radiation
- Individuals that reside in certain geographic locations such as Australia are at higher risk for Aks and skin cancer.
- Individuals that have a genetic disorder that increases the risk of developing AKS
- Individuals suffering from HPV (Human papillomavirus) which is the cause of warts have been detected in AKs and skin cancers
- Individuals with low immune systems
How We Diagnose AKs or SCC
AK is frequently diagnosed by touch and visual inspection of suspicious or non-healing skin lesions. That being said, there are a lot of other types of skin lesions and many skin cancers may resemble AKs therefore the best approach is to biopsy the lesion before treatment. The final pathological diagnosis of the lesion dictates the treatment plan.
Common skin lesions that resemble AKs
- SCC (Squamous cell carcinoma)
- BCC ( basal cell carcinoma)
- Inflamed SKs (seborrheic keratosis)
- Inflammatory dermatoses (psoriasis, seborrheic dermatitis)
- Viral wart
- Age spot ( Solar lentigo)
How can we avoid unnecessary biopsy and surgeries?
In many cases, there are numerous skin lesions that look suspicious for AKs and SCC with the naked eye exam. Fortunately, Dr. Shafa is one of the few physicians well trained for dermoscopic evaluation of suspicious skin lesions. Dermoscopy is a non-invasive procedure that involves the use of a handheld tool that combines magnification and a transilluminating light source to aid in the diagnosis of many cutaneous lesions. Dermoscopic evaluation of suspicious skin lesions is very helpful to differentiate lesions with color such as melanoma from pigmented Aks. Many other skin lesions have a known appearance under the dermoscope such as strawberry patterns indicating Aks or dots indicating warts. For uncertain diagnoses, histopathologic examination remains the gold standard for such cases.
What type of AKs resembling skin lesions require skin biopsy?
- If lesions are larger than 1 cm, have a thick texture, are growing, are tender, ulcerate, or fail AKs tx such as cryotherapy.
- If we are suspicious of other diagnoses, then a skin biopsy is warranted.
How is a skin biopsy performed?
Although deep shave biopsy or punch biopsy are acceptable methods of taking a sample of the skin lesion for microscopic evaluation, Dr. Shafa prefers to perform a punch biopsy or excise the lesion since she believes her clean-cut and delicate suture placement at the site of biopsy not only leave less scarring than shave biopsy but a sample of the full skin thickness is a safer, more accurate skin biopsy. An insufficient biopsy depth will compromise the pathologist’s ability to rule out an invasive SCC.
What is the treatment for AKs?
As mentioned above, there are a lot of details different in each skin lesion along with other factors that dictate the treatment plan. Aks can be treated as simply as applying liquid nitrogen to the lesion which makes it to scab and fall off to other more complicated modalities that will be discussed during the visit. We offer individualized treatment plans and will provide the service most suitable for you.
Call us to make an appointment for a medical visit to evaluate your skin lesions.*