Actinic Keratosis is Dangerous

Actinic Keratosis can be the first step in the development of skin cancer. Therefore, it is referred to as a precursor of cancer or a precancer. It is estimated that up to 10 percent of active lesions, which are redder and more tender than the rest, will take the next step and progress to squamous cell carcinomas. They are usually not life threatening, provided they are detected and treated in the early stages. However, left untreated, they can grow large and invade the surrounding tissue. On rare occasions, they metastasize or spread to the internal organs.

The most aggressive form of keratosis, actinic cheilitis, appears on the lips and can evolve into squamous cell carcinoma. When this happens, roughly one-fifth of these carcinomas metastasize. The presence of actinic keratoses indicates that sun damage has occurred and that any kind of skin cancer—not just squamous cell carcinoma—can develop.

What Does Actinic Keratosis Look Like?

The look of actinic keratosis varies depending on where it’s found on the body:

• Back of hand—scattered, thickened red, scaly patches.
• Sun-damaged forehead or bald scalp—small red bumps and/or small tan crusts.
• Lower lip—fissures filled with dried blood and large keratosis covered with thorny scale.
• Cheek and ear-crusted lesions—ranging in color from red to brown.

If you spot any of these, consult your doctor promptly.

Causes of Actinic Keratosis

Sun exposure is the cause of almost all actinic keratoses. Sun damage to the skin accumulates over time, so that even a brief exposure adds to the lifetime total. The likelihood of developing keratoses is highest in regions close to the equator. However, regardless of climate, everyone is exposed to the sun. Ultraviolet rays reflect off sand, snow, and other surfaces; about 80 percent can pass through clouds.

Are You at Risk?

People who have fair skin, blonde or red hair, blue, green, or gray eyes are at the greatest risk. Because their skin has less protective pigment, they are the most susceptible to sunburn. Even those who are darker-skinned can develop keratoses if they expose themselves to the sun without protection. African-Americans, however, rarely have these lesions.

Individuals, who are immunosuppressed as a result of cancer, chemotherapy, AIDS, or organ transplantation, are also at higher risk.

How is It Treated?

There are a number of effective treatments for actinic keratosis. The right treatment for you will depend on the size and site and aggressiveness of the lesion, as well as the health and wishes of the patient. Your dermatologist can help you choose among the following possible treatments:

Cryosurgery– This is the most commonly used procedure. It involves freezing off the lesions through application of liquid nitrogen with a special spray device or cotton-tipped applicator. It does not require anesthesia and produces no bleeding. There is a slight risk of scaring and hypopigmentation.

Topical Medications – Multiple topical medications can be used at home to treat these lesions, especially when the lesions are large or numerous. Those medications include fluorouracil®, imiquimod®, Picato®, Soloraze®.

Shave removal, Curettage and Electrodessication, or surgical removal

Photodynamic therapy

Actinic keratosis is the warning signal for skin cancer. Heed that signal. If you believe you may have actinic keratosis anywhere on your face, body, or scalp, make an appointment with your dermatologist today.

What is Photodynamic Therapy?

Photodynamic therapy (PDT) is a medical treatment that uses special drugs, known as photosensitizing agents, and light to kill cancer cells. These drugs become effective only when activated by specific kinds of light. PDT is also known by other names such as photoradiation therapy, phototherapy, or photochemotherapy.

How PDT Works:

1. Application of the Photosensitizing Agent: Depending on the treatment area, the photosensitizing agent can be administered through a vein or applied directly to the skin.
2. Absorption by Cancer Cells:
   The drug is absorbed by cancer cells over a period, which can range from a few hours to a few days.
3. Light Activation: Once absorbed, the treatment area is exposed to light, which causes the drug to react and form a special oxygen molecule that kills the cancer cells. PDT may also work by destroying the blood vessels that feed the cancer cells and by triggering an immune response against the cancer.

Types of Light Used:

Advantages of PDT:

1. Minimal Long-term Side Effects: When used correctly, PDT has no long-term side effects.
2. Less Invasive: PDT is less invasive compared to surgery.
3. Quick and Outpatient: The procedure usually takes a short time and is often done on an outpatient basis.
4. Precise Targeting: PDT can target cancer cells very precisely.
5. Repeatable: Unlike radiation, PDT can be repeated multiple times at the same site if necessary.
6. Minimal Scarring: There is usually little or no scarring after the site heals.
7. Cost-effective: PDT often costs less than other cancer treatments.

Limitations of PDT:

1. Limited Reach: PDT can only treat areas that light can reach, making it suitable mainly for cancers on or just under the skin, or in organ linings accessible by light.
2. Not for Large or Deep-seated Cancers: PDT is ineffective for treating large cancers or those deeply embedded in the skin or other organs.
3. Limited Spread: It cannot treat cancers that have spread to multiple areas.
4. Light Sensitivity: The drugs used in PDT cause heightened sensitivity to light, necessitating special precautions post-treatment.
5. Blood Disorders: PDT is not suitable for people with certain blood diseases.

Applications of PDT:

• Cancer Treatment: PDT is used to treat specific types of localized cancers, helping to extend patients’ lives and improve their quality of life.
• Pre-cancers: It is also effective for certain pre-cancerous conditions.

Side Effects of PDT:

Common Side Effects:

1. Photosensitivity Reactions: Sensitivity to bright light and sunlight, causing redness and tingling or burning sensations on the skin. Post-treatment care includes avoiding strong light and using protective clothing.
2. Skin Changes: Redness, swelling, blisters, burning sensations, itching, or color changes in the treated area, lasting from hours to days.
3. Swelling and Pain: Swelling in the treated area can cause pain and affect tissue and organ function.
4. Immune System Changes: PDT can stimulate or sometimes weaken the immune system. In rare cases, it might cause skin cancer at the treatment site, possibly due to immune system weakening.