Q: I have had a lesion on my face for about six months now and finally decided to do something about it. Perhaps incorrectly, I bypassed my primary care physician and made an appointment with a dermatologist who removed it by scraping it off and sent it for biopsy. I’ve just learned I have (or had) a hyperplastic actinic keratosis – not cancer but pre-cancerous. He wants to see me again and stated the lesion will require some further treatment. So what does that mean? Is it cancer or is it benign? I’m really confused.
A. Actinic keratosis, also referred to as solar or senile keratosis is a pre-cancerous skin condition that is seen in individuals with skin that has typically been excessively exposed to the sun. It commonly presents on the face, forearms, neck, hands, scalp, neck, ears and lips. The lesions are noticeable patches of red/brown/flesh colored that don’t heal or go away. An actinic keratosis enlarges slowly and commonly causes no signs so symptoms other than the lesion(s) on the skin that take years to develop. They may take on an appearance of being scaly or crusty and may appear in sizes from that of a pea to one inch in diameter. The skin around the site may be red and irritated. There are instances when a lesion will resolve on its own; however, it will typically return following new sun exposure. When scratched or picked off, the lesion will grow again.
Early treatment is recommended to keep the lesion from progressing to a form of skin cancer known as squamous cell carcinoma. Treatment may include numbing the area and removing the growth through scraping, which is what you underwent. If necessary, electrosurgery may be performed to control any bleeding and to destroy any abnormal cells. This method is rapid; however, it can cause scarring.
Cryotherapy (freezing with liquid nitrogen) is another form of treatment that generally does not cause scarring. Healing may take up to two weeks. Some individuals with darker colored skin may find the area will have a lighter pigment than the skin that previously surrounded the lesion.
Photodynamic therapy (PDT) uses light and aminolevulinic acid, a medication that is placed on the skin. The light causes the medication to destroy the keratosis. Then there is laser therapy, creams and ointments, and dermabrasion. Each procedure has both advantages and disadvantages, so speak with your health care specialist to determine what is right for you should you discover more lesions.
Because you were diagnosed with actinic keratosis, you are at an increased risk for developing squamous cell carcinoma. There is no way to determine if this will develop into squamous cell carcinoma or not and when that might occur. You don’t indicate precisely where the lesion was. Those on the ears and lips are at high risk of developing into cancer because of the sensitivity to the two areas with sun exposure.
Prevention is never too late. Use a sunscreen when you are out of doors in the sun. Re-visit your dermatologist regularly for an examination of your skin – especially if your work or activities take you into the sun. Peak hours of ultravoilet exposure are between the hours of 10 AM and 4 PM. Make an effort, if possible, to limit your sun exposure during those times. Use a sunscreen that blocks both UVA and UVB rays with a SPF (sun protection factor) of at least 30. Remember that the sun can cause damage even on cloudy days and in the winter time, so apply that protection all year long.Cover up with protective clothing and – above all else – avoid tanning booths and sun lamps that can elevate that risk even more.
