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Actinic Keratosis
By peace | December 3, 2006
An actinic keratosis (AK), also known as a solar keratosis, is a precancerous skin growth usually caused by sun exposure. It is a small, rough spot occurring on skin that has been chronically exposed to the sun. Actinic keratoses generally measure in size between 2 to 6 millimeters in diameter (between the size of a pencil point to that of an eraser). They are 
usually reddish in color and often have a white scale on top.
In addition to feeling rough, actinic keratoses may feel sore or painful when fingers or clothing rub against them.
Those who develop actinic keratoses tend to be fair-skinned people who have spent a lot of time outdoors at work or at play over the course of many years. Their skin often becomes wrinkled, mottled, and discolored from sun exposure.
Common locations for actinic keratoses are the face, scalp, back of the neck, upper chest, as well as the tops of the hands and forearms. Men are more likely to develop AKs on top of the ears, whereas women’s hairstyles often protect this area.
Actinic keratoses are precancerous (premalignant), which means they can develop into skin cancer. However, relatively few of them actually become cancers, a process that typically takes years. When a malignant change does occur, the cancer is called a squamous cell carcinoma.
When patients are diagnosed with this condition, they often say: ” But I never go out in the sun!” The explanation is that it takes many years or even decades for these keratoses to develop. Typically, the predisposing sun exposure may have occurred many years ago. Short periods of sun exposure do not generally either produce AKs or transform them into skin cancers.
Symptoms
- Rough and dry textured skin lesion
- A macule, patch, or growth on the skin
- Limited to a discrete area (localized)
- Located on the face, scalp, back of the hands, chest or other sun-exposed areas
- Gray, pink, red (erythematous), or the same color as the skin
- Initially flat and scaly on the surface, becoming slightly raised
- Becoming hard and wart-like or gritty, rough, and “sandpapery” — may develop a horn-like texture from overgrowth of skin keratin layer (hyperkeratosis)
Diagnosis
Most of the time, doctors can diagnose an actinic keratosis just by examining it. If the AK is especially large or thick, a biopsy may be advisable to make sure that the spot in question is just a keratosis and has not become a skin cancer.
There are other spots, called seborrheic keratoses, that are not caused by sun exposure and have no relationship to skin cancers. These are raised brown lesions that do not appear only on areas of the skin that are exposed to the sun. They also often run in families.
Treatment
The best treatment for an AK is prevention. For light-skinned individuals, this means minimizing their sun exposure. By the time actinic keratoses develop, however, the relevant radiation is often so far in the past that prudent preventive measures play a relatively small role. Fortunately, treatment methods are usually simple and straightforward:
* Cryosurgery: Freezing AKs with liquid nitrogen often causes them to slough off and go away.
* Other forms of surgery: Doctors sometimes cut away or burn off AKs.
* 5-fluorouracil: Creams containing this medication cause AKs to become red and inflamed before they fall off. Although effective, this method often produces unsightly and uncomfortable skin for a period of weeks, thus making it impractical for many patients.
* Photodynamic therapy: This relatively new therapy involves injecting a chemical into the bloodstream that gathers in AKs and makes them more sensitive to exposure to a specialized form of light.
Prevention
Minimize sun exposure and protect skin from the sun. Wear protective clothing such as hats, long-sleeved shirts, long skirts, or pants. Ultraviolet light is most intense midday, so try to avoid exposure during these hours.
Use high-quality sunscreens, preferably with SPF (sun protection factor) ratings of at least 15. Pick a sunscreen that blocks both UBA and UVB light. Apply sunscreen at least half an hour before exposure, and reapply frequently.
