How to Spot Actinic Keratosis: Early Warning Signs of Precancerous Skin

Actinic keratosis is a common skin condition and often an early warning sign of potential skin cancer. Over 58 million patients in the United States are affected by these precancerous lesions, many of which are caused by years of cumulative ultraviolet (UV) exposure.

These rough, scaly patches often develop on areas frequently exposed to the sun and are common among those over the age of 40.

What makes actinic keratosis concerning is its potential to progress into squamous cell carcinoma, the second most common type of skin cancer.

What is Actinic Keratosis?

Actinic keratosis is a skin condition resulting from long-term exposure to UV radiation. It typically appears as rough, scaly patches or small crusty spots on your skin. These spots can vary in color from red or pink to brown or even the same tone as your skin. These patches are most commonly found on sun-exposed areas such as the face, scalp, ears, neck, forearms, and hands.

These patches may feel dry or rough, and some patients may experience itching, burning, or sensitivity in the affected areas. While some actinic keratosis patches are small and subtle, they can grow larger over time and may form multiple patches in one area.

Precancerous Condition

Actinic keratosis is a precancerous condition because it has the potential to develop into squamous cell carcinoma (SCC). According to the Skin Cancer Foundation, 10% of actinic keratoses progresses to SCC. Studies suggest the risk could range from 0.25% to 20% per year for an individual lesion. That’s why it is important to monitor and treat this condition to reduce the risk of it becoming more serious.

The link between actinic keratosis and cancer stems from DNA damage caused by prolonged UV exposure. UV rays harm skin cells, interfering with their ability to repair themselves. Over time, this damage can lead to abnormal cell growth and increase the risk of cancer.

Actinic keratosis serves as a clear warning sign of sun damage to the skin and potential skin cancer. Therefore, most dermatologists recommend treatment, even for small or mild cases, as a precautionary measure.

Early Warning Signs

Actinic keratosis can develop slowly, often starting with small changes in your skin that are easy to miss. Some of the most common early indicators to watch for include the following:

• Rough or dry patches: You may feel areas of roughness that differ from the surrounding skin. These patches can sometimes feel like sandpaper.
• Changes in skin color: Affected areas may appear red, pink, or brown. In some cases, the discoloration may blend in with the natural skin tone.
• Scaly or crusty texture: The surface of the patch might become scaly or crusty. Even if the flaky layer comes off, it tends to return.
• Itching, burning, or sensitivity: Some people experience mild discomfort, such as itching, tenderness, or a slight burning sensation.
• Thickened or raised skin: As actinic keratosis progresses, the patches may become thicker or develop a more noticeable raised texture.
• Clusters of lesions: Multiple patches often form in the same area, especially on sun-exposed parts of the body like the face, ears, scalp, hands, and arms.

Remember that paying attention to these early signs can make a significant difference in managing this condition and preventing further complications.

Risk Factors for Actinic Keratosis

Actinic keratosis is primarily caused by long-term exposure to UV radiation. However, certain factors can increase your risk of developing this condition:

• Frequent sun exposure: Spending a lot of time outdoors without proper protection (sunscreen, protective clothing, shade) increases your risk. This includes activities like gardening, swimming, or outdoor sports, especially during peak UV hours.
• Tanning beds: Artificial UV radiation from tanning beds significantly increases your risk of skin damage, including actinic keratosis.
• Fair skin tone: Individuals with fair skin, light hair, and light-colored eyes have less melanin, making them more susceptible to UV damage..
• Older age: Actinic keratosis is more common in older adults due to the cumulative effects of UV exposure over time.
• Weakened immune system: People with weakened immune systems, such as those undergoing chemotherapy, organ transplant recipients, or those with certain medical conditions, are at higher risk.
• History of sunburns: Frequent or severe sunburns, especially in childhood or adolescence, significantly increase your lifetime risk of actinic keratosis.
• Living in sunny or high-altitude regions: Living in areas with intense sunlight or at higher altitudes increases UV exposure, increasing your risk of skin damage.

Always remember to apply sunscreen, seek shade during peak sun hours, and wear protective clothing to lower your risk of actinic keratosis.

Treatment Options

Actinic keratosis requires treatment to prevent it from progressing into squamous cell carcinoma. The best course of treatment depends on several factors, including the number and location of lesions, your overall skin condition, and your preferences.

Topical Medications

• Imiquimod (Aldara, Zyclara)
  This prescription cream is an immune response modifier. It stimulates your body's immune system to recognize and attack the abnormal cells causing actinic keratosis.
  Common side effects include redness, swelling, and crusting at the application site, indicating the immune system's activity. The dosing schedule varies depending on the specific formulation.
• Fluorouracil Cream
  This topical medication acts as a chemotherapy agent. It works by directly targeting and destroying abnormal skin cells. Studies show that fluorouracil cream can clear 70-90% of lesions after 2-4 weeks of treatment. It's applied directly to the lesions for several weeks, causing redness, irritation, and peeling as the damaged cells are eliminated.

In-Office Procedures

These procedures are typically used when topical medications are not suitable or for specific patient needs. They are performed by a dermatologist in their office setting.

• Cryotherapy
  This quick and effective method involves freezing the lesions with liquid nitrogen. The abnormal cells die and eventually slough off. Cryotherapy is well-suited for isolated lesions and has minimal downtime.
• Curettage and Electrosurgery
  This two-step procedure removes the lesion. First, a curette scrapes off the abnormal tissue. Then, electrosurgery uses heat or electricity to destroy any remaining abnormal cells at the base. This method is often used for thicker lesions.
• Photodynamic Therapy (PDT)
  PDT uses a light-activated treatment. A photosensitizing agent is applied to the affected area, followed by exposure to a specific light source. The light activates the agent, which selectively targets and destroys abnormal cells while sparing healthy tissue. PDT is particularly useful for larger areas with multiple lesions.
• Laser Surgery
  This procedure uses focused beams of light to precisely remove the damaged skin cells. It's often preferred for lesions in sensitive areas or for patients who want minimal scarring. Laser treatment can be especially effective for lesions resistant to other treatments. While temporary redness or swelling may occur, laser surgery offers a targeted and efficient method for removing precancerous skin.

Speak with Your Doctor

If you notice rough or scaly patches on your skin that feel different from the surrounding areas, particularly in places frequently exposed to the sun, it is time to speak with your dermatologist.

Remember that these patches may vary in color, appearing red, pink, brown, or blending with your skin tone. Discomfort, such as itching, tenderness, or a burning sensation, can also indicate the need for an evaluation, especially if the affected area persists or starts to grow.

Patients with significant sun exposure, fair skin, or a history of sunburns are more likely to develop actinic keratosis. Even if no visible lesions are present, those at higher risk can benefit from regular skin exams to catch early signs of damage.

Your dermatologist can diagnose actinic keratosis through a physical exam and, if necessary, perform a biopsy to confirm the findings or rule out skin cancer. Check-ups are especially important because this condition cannot be treated with routine skincare products or home remedies.