Actinic keratosis (sometimes called solar keratosis) is a common skin condition among the elderly, but one that may not sound familiar to many. Primarily caused by long-term sun damage, it is a precancerous lesion, meaning that it may become skin cancer in the future if it is left untreated.
What is actinic keratosis, and why is it important?
Actinic keratosis is a lesion on the skin that is considered to be precancerous.1 It is not just a cosmetic issue but a condition that can potentially become fatal if left untreated. While only a minority of actinic keratosis eventually become skin cancers, the current medical opinion in Canada and the United States is to treat every case of actinic keratosis as we can’t predict which ones will progress to become skin cancer.
Is actinic keratosis a type of cancer?
The majority view among physicians is that actinic keratosis is not cancerous yet. The statistics of how often actinic keratosis becomes skin cancer vary widely, some as low as 2%, some as high as 20%, depending on how it is defined or counted.2 The important part isn’t the semantics or the medical technicalities, but that patients get their actinic keratoses treated promptly.
What does actinic keratosis look like?
Actinic keratosis will be scaly and often red.3 It will also be rough; quite often, in the early stages, you will feel the difference in skin texture before the visible symptoms appear. The lesions appear primarily in sun-exposed areas of the skin such as the face, arms, legs, or the scalp (if exposed). Sometimes it can appear on the lips as well (called actinic cheilitis).
Should I get it checked or get my mom/dad to see a doctor?
If you suspect that you have actinic keratosis, have it checked by a doctor. Encourage your parents to book an appointment with their doctor to have it checked. It’s better to have it confirmed than to stress over what it could be.
Who is at risk?
Age is by far the most significant risk factor. With very few exceptions,4 actinic keratoses are rarely seen in teenagers and young adults. It is a skin condition that is the result of accumulated sun exposure over time. Additional risk factors include:
- Light skin tone
- Previous history of actinic keratosis or skin cancer
- Live in a sunny climate.
- People with compromised immune systems
Can I prevent actinic keratosis?
Long-term sun exposure is what causes actinic keratosis. Sun protection is the simple answer, but it has to be consistent. Actinic keratosis develops over decades of sun damage; it’s not like a sunburn. The earlier you develop proper sun protection habits, the better protected you will be against actinic keratosis and skin cancer.
What are the best practices for prevention?
Daily sunscreen use is the most practical recommendation for most people because it is an easy habit to get into and one that can be reasonably followed daily. However, additional practices like avoiding sun exposure from 10 AM to 2 PM, staying in the shade, and wearing long sleeves and a hat all help to reduce total sun exposure.
Will insurance cover treatment?
Insurance policies vary widely. Always check the details yourself. In Canada and the United States, actinic keratosis is considered a potentially dangerous precancer and will most likely be covered by health insurance. Actinic keratosis is not just an aesthetic concern; it is recognized as a medical condition.
What is the process of diagnosis and treatment?
The diagnosis is usually straightforward. The doctor will be able to diagnose by examining your skin. Sometimes a biopsy is taken and analyzed to confirm a difficult diagnosis. There are several treatment options for actinic keratoses. All treatments have pros and cons. In most cases, your doctor will recommend a treatment that best suits your case and will explain why.
What is the biggest misconception about actinic keratoses?
The worst misconception is probably the belief that actinic keratosis is not a serious concern. Actinic keratosis is not only a cosmetic issue but a medical one. The other common misconception is that once actinic keratosis is removed, they don’t have to worry about sun damage anymore. Actinic keratosis is evidence of sustained sun damage, and its presence means that the patient needs to be much more careful about sun exposure going forward.
What are some of the available treatments for actinic keratosis?
- Cryotherapy: Freezes the lesion, usually using liquid nitrogen. Cost-effective and is usually used when the lesion is singular and not very large.
- Excision/Curettage: Both are methods of surgical removal of the lesion. It is usually a one-time procedure and very effective.
- Zyclara/Aldara/5FU: These are topical medications that are applied to actinic keratosis. The main advantage is that no surgery is required, and it is suited to treat large areas that are affected. It can also improve subclinical (not visual yet) problems surrounding the area. The main drawback is that they can take weeks or months and can be unpleasant for the duration of the treatment.
- Photodynamic Therapy: An alternative treatment to actinic keratosis where a laser is applied to an area following a chemical that helps amplify the effect of the laser.
For more information about actinic keratosis, please visit actinickeratosis.ca
1Some researchers believe that it is, in fact, the earliest stage of skin cancer. Either way, there is no disagreement that all actinic keratoses should be treated.