Actinic Keratosis
Actinic Keratosis is also called solar keratosis because it is caused by the effects of solar radiation on the skin.
-It is a lesion that appears on the skin and resembles a fragile, flat, scaly plaque or “flake” of keratinized tissue.
-In most cases, we do not refer to a single actinic keratosis but to Actinic Keratoses, because they almost never appear individually and are usually multiple, merging lesions.
-Initially, they appear as very small plaques that grow slowly and are often felt more easily than they are seen.
-Over time, they develop, become grey or reddish, may itch, feel tight or even bleed.
Actinic Keratoses – Who Do They Affect?
There is one simple rule:
The more someone is exposed to the sun, the greater the likelihood that they will develop Actinic Keratoses on their skin. If there is also a genetic predisposition, the likelihood is even greater.
Therefore, people who spend many hours outdoors and are exposed to the sun, such as farmers, laborers, construction workers, etc., or people who sunbathe extensively or use artificial tanning facilities, such as solariums, are more likely to develop Actinic Keratoses.
They are more common in men and usually affect older individuals with fair skin, blond hair and blue, grey or green eyes.
They may also develop following exposure to X-rays or industrial chemical agents.
White people are more susceptible than Asian or Black populations.
Actinic Keratoses – Where Do They Appear?
They appear on areas of the body that are exposed to the sun.
The main areas where they are found are:
- the bald area of the scalp
- the ears, usually the upper part of the ear
III. the nose
IV. the lips, most commonly the lower lip
- the forehead
- the face
- the neck
- the shoulders
- the backs of the hands
- the shins, for example in fishermen.
Actinic Keratoses – Are They Dangerous?
Actinic Keratoses are proven precancerous skin lesions. More specifically, we now know that in approximately 10 to 15% of cases, they may develop into Squamous Cell Carcinoma (SCC). We also know that approximately 45 to 65% of Squamous Cell Carcinomas originate from precancerous lesions, such as actinic keratoses or actinic cheilitis that develops on the lips.
If an Actinic Keratosis develops into squamous cell carcinoma, there is a 10 to 15% chance that it may cause local or distant metastases, spread to internal organs and threaten the patient’s health and life. The more actinic keratoses someone has on their skin, the greater the likelihood that one or more of them will develop into skin cancer. These cancers may often be highly aggressive and cause extensive damage to the skin and body tissues.
Actinic Keratoses – Treatment
Actinic Keratoses should be treated in order to prevent the possibility of their transformation into skin cancer. Before beginning any treatment, we must ensure that the corresponding lesion is not already cancerous. We therefore collect material from the area of the keratosis using either a curette or a scalpel, through a shave biopsy, and perform a simple biopsy of the lesion. Once the possibility of malignancy has been excluded through biopsy, we can safely proceed with the selected treatment.
The most common treatment methods for Actinic Keratoses are:
- cryotherapy, usually with liquid nitrogen
- Laser cauterization
- electrocautery
- photodynamic therapy (PDT)
- the topical application of pharmaceutical preparations
- radiation therapy
- surgical excision with biopsy and plastic reconstruction.
Because Actinic Keratosis lesions are numerous and merging and are located in the epidermis without penetrating deeply, the best treatments are those that achieve controlled destruction of the epidermis at a local level. In these cases, tissue regeneration occurs through immediate epithelialization.
We recommend surgical removal only when there are isolated, localized lesions of small dimensions.
Actinic Keratoses – Recommended Treatment
Our recommendation for treating Actinic Keratoses is the application of CO2 Laser or Alexandrite Laser. With these Lasers, we essentially burn the hyperkeratotic lesions superficially without damaging the deeper tissues.
The Laser treatment procedure is very simple, almost painless and quick.
In many cases, local anesthesia is not even required. We apply the Laser beam directly onto the keratoses and cauterize the lesions.
We then use healing and antiseptic creams until the area has healed. Recovery usually takes seven to ten days.
Actinic Keratoses – Prognosis / Prevention
Actinic Keratoses have an excellent prognosis. Since they are not cancerous, their treatment, regardless of the selected method, is very safe, easy and effective.
What is also extremely important for the long-term prognosis is prevention.
The best prevention against Actinic Keratoses is avoiding the sun.
This can be achieved:
by having skin lesions regularly examined by a specialized doctor and surgically removed if they are considered suspicious.
by wearing a hat and clothing that covers the skin
by avoiding skin exposure to the sun between 12:00 and 17:00
by using high-protection sunscreen, SPF >30, several times throughout the day
by avoiding sunburn
by avoiding sunbathing
by avoiding artificial tanning, such as solarium use
by completely avoiding sun exposure for newborns and limiting exposure for young children up to the age of 5
by performing a monthly self-examination of keratoses and skin lesions
