Dr. Denis Grillo, Ear, Nose & Throat, 10/16/12

Actinic keratoses are growths that appear on the head and neck area, as well as other parts of the body. They are characterized by exposure to the sun and damage to the skin, a common finding here in Florida. Most common sites are the forehead, scalp, and ears. 

When actinic keratoses first appear, they look like patches of tiny red blood vessels that are visible through the top layers of the skin. They have a tendency to grow redder and more raw in the summer when exposed to the sun and the growth slows and color fades in the wintertime when there is less sun exposure. 

The skin develops a texture that is similar to sandpaper, rough and scaly. Actinic keratoses (AKs) can vary in size from less than .25 inch to larger than 1 inch across. They will get bigger with time and they will become slightly more raised and rough with time as well. The edges of these lesions are not well defined, in other words irregular. 

Typically, AKs are not too symptomatic, but at times they can become itchy and irritated, especially if rubbed by clothing, hats, eyeglasses, and if the irritation is severe enough that the top layer is knocked off it can bleed. 

AKs are not skin cancers, but they are in some medical circles considered precancerous. A small percentage of these lesions do turn into squamous cell cancer, which is a type of skin cancer that can be severe. Typically, it is slow growing. But nevertheless, it is a skin cancer. 

Actinic keratoses, in the early stages, skin conditioners and moisturizers such as sunscreen, helps when you are outdoors. 

Removal of more advanced lesions includes shave excision, which is done by a very sharp scalpel blade, shaving it at the skin level. Other methods include freezing the diseased tissue with liquid nitrogen and eventually the tissue dies and new healthy tissue grows back into the site. Another technique is called curetting and electrodesiccation, which means we scrape the growth from the skin and an electric needle is applied to the treated areas to destroy any remaining tissues and seal blood vessels to stop bleeding. 

There are some anti-cancer creams that can be applied to the area. Treatments can extend to three to five weeks. Other common treatments include chemical peels, which is done by applying various chemicals to cause the actinic keratoses to blister and peel away over time and dermabrasion, which is a form of “sanding” the skin to remove the growth. Also, laser light is sometimes used, depending on where the lesion is located. 

Prevention is still a very important factor and the same tip for prevention of skin cancer holds true here. Stay out of the sun between 10 a.m. and 4 p.m. when the suns rays are the strongest and wear protective clothing, long pants, long-sleeved shirts, wide-brim hats, and wear sunglasses. Remember, you have to protect your eyes as well and the skin around them. Use a sunscreen with at least a sun protection factor of 15, when you are outdoors applied repeatedly and avoid tanning booths or sun lamps.