Scaly, dry skin spots—often called “sun spots”—an under recognized but treatable condition
“I’ve never heard of it.”
This is what I most often hear when my patients are diagnosed with actinic keratosis, which is alarming given the fact that these unknown pre-cancerous spots are the third most frequently diagnosed skin problem.
Actinic keratosis, or AK, is a pre-cancerous skin condition, often mistaken for sun spots or simply “dry skin” and is typically diagnosed in older adults. AK affects upwards of 58 million Americans, who may be covered in these “sun spots” after having spent years soaking up the sun—getting a nice bronze tan (or sunburn) while unwittingly absorbing the sun’s harmful UV rays.
As a dermatologist, I am proud of and happy about all of the increased education we have seen around melanoma and skin cancer protection. However, we have not seen enough education in the treatment of pre-cancers such as AK. For current or former sun-worshippers, gardeners or outdoors persons, the damage has already been done.
Treatment is important and could be life-saving. While most AKs remain benign, approximately 5 to 10 percent develop into squamous cell carcinoma, a type of skin cancer, within an average of two years.
AKs are the result of years of cumulative sun damage and are most prevalent in older adults who have spent a lot of time in the sun over the course of their lives. They are rough-textured, sensitive, dry, scaly patches on the skin that can range in color and vary in size and most often appear on parts of the body that are regularly exposed to sunlight such as the face, scalp, ears, neck, hands and arms. Individuals with fair skin should be on high alert, as AKs are more common in this population.
It is not typical for the sun to affect only small patches of the skin – therefore, people who are diagnosed with an AK will typically develop more AKs in the future. So, while there may be one AK on the surface, more nascent AKs will present over time.
(These treatment options could optionally be included in a sidebar rather than in the text of the article.)
Many treatment options are available and should be discussed with your dermatologist. Treatments include:
- Photodynamic Therapy (PDT). A photosensitizing (reacts with light) agent is applied to the AKs. The treated area is exposed to a light, activating the agent. The period between application and exposure will vary and depend on the photosensitizing agent that is used. This treatment targets pre-cancers and causes little damage to the surrounding normal tissue. Some redness, swelling and a burning sensation during therapy often occurs. Not all dermatologists have the equipment to perform this treatment – make sure your dermatologist does.
- Cryotherapy (freezing). AKs are frozen with an extremely cold substance such as liquid nitrogen. There is no cutting or anesthesia required. This method causes the lesion(s) to shrink or become crusted and then fall off. After treatment there may be temporary redness and swelling. In some patients this treatment can cause permanent light/white spots on the skin.
- Creams. A topical medication is applied to the affected skin. The course of treatment can range from days to months, depending on the topical medication that is used. Redness, swelling and ulceration may occur during treatment.
- Curettage (scraping). A curette is used to scrape off cells that are damaged. A local anesthetic is required for this procedure. Scarring and skin discoloration may occur at the site of the treatment.
- Chemical Peel. Chemicals are applied directly to the AKs. The chemical causes the top layer of skin to slough off. This layer of skin is usually replaced within seven days. Anesthesia is necessary for this procedure and temporary discoloration and irritation can occur.
- Surgical Excision. The entire lesion, in addition to some healthy tissue, is removed. Scarring is possible.
- Lasers. A laser is focused on the lesion. The laser cuts through the skin tissue without causing bleeding. Local anesthesia may be required. This treatment can cause pigment loss in the skin.
Frequent skin examinations are the key to early detection and preventing skin cancer. If you think you have AKs, it is imperative to talk to your dermatologist about the best treatment options, since there is no way to know ahead of time which AKs will become cancerous. Do not ignore your sun spots!
To learn more, please visit www.spotsigns.com. This site has a variety of educational tools including a list of signs, prevention advice and treatment options. Or, feel free to contact Dr. Amos at or (724) 473-0660 visit our website at www.amosmd.com.