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Actinic keratosis (AK), a common skin alteration often linked to long-term sun exposure, typically presents as small, scaly spots on the skin's surface. While the majority of these lesions are benign, there is a small risk that they could evolve into squamous cell carcinoma. According to Dr. Sean R. Christensen, a dermatologic surgeon and professor at Yale School of Medicine, it is this potential for malignancy that prompts dermatologists to recommend treatment for AK lesions.

Yale Medicine, with its specialized expertise in skin cancer, operates as a tertiary care center, receiving referrals of complex cases from dermatologists across various practices. Dr. Kathleen Suozzi, an associate professor and faculty member in Dermatologic Surgery and Cutaneous Oncology, highlights the center's extensive experience with thousands of unique cases.

Symptoms of Actinic Keratosis

Actinic keratosis often manifests in multiple lesions, predominantly on sun-exposed areas such as the ears, nose, cheeks, temples, and bald scalps, as well as on the forearms and the backs of hands. These lesions have a characteristic rough texture, likened to sandpaper, and may grow to a size of an eighth to a quarter of an inch. While painless, they can occasionally cause itching or tenderness and may appear scaly, crusty, or warty. Dr. Christensen advises that any new skin growth that persists for over a month should be examined by a healthcare professional.

Risk Factors for Actinic Keratosis

The risk of developing AK increases with accumulated sun exposure, making it more prevalent among adults over 55, particularly those with a history of outdoor activities or occupations. Men are somewhat more susceptible due to less frequent use of sun protection, and while fair-skinned individuals are at higher risk, people with olive or darker skin are not exempt. The incidence of skin cancer, including AK, is rising among younger demographics as well.

Diagnosis of Actinic Keratosis

A dermatologist can usually diagnose AK through visual inspection. However, if a lesion appears suspicious or fails to respond to initial treatments, a biopsy may be performed to confirm the diagnosis, as explained by Dr. Suozzi.

Treatment Options for Actinic Keratosis

Treatment strategies for AK include:

Topical Destruction: For isolated lesions, dermatologists often opt for cryotherapy, using liquid nitrogen to freeze and destroy the affected skin area. This method may cause temporary discomfort but results in healing within weeks.

Topical Treatments: For widespread AK, field treatments like topical creams are used to target visible lesions and prevent new growths. Fluorouracil (5-FU) is a common prescription, despite its potential to cause skin irritation.

Immunotherapy: Imiquimod, an immunotherapy cream, stimulates the immune system to combat pre-cancerous cells, with effects similar to fluorouracil.

Anti-inflammatory Therapies: Diclofenac gel is a less irritating alternative but requires prolonged use for optimal results.

New Medications: Klisyri, a newer medication, has shown effectiveness in clinical trials for treating AK.

Photodynamic Therapy: This method involves the application of a photosensitizer followed by exposure to specific light wavelengths to eliminate abnormal skin cells. It is effective for multiple lesions and generally less irritating than topical treatments.

Yale Medicine's approach to AK is distinguished by its focus on skin cancer diagnosis and treatment, with a comprehensive range of therapies, including photodynamic light therapy and laser treatments. Dr. Christensen emphasizes the importance of sun protection as a complementary measure to medical therapy, stating that regular sunblock use can lead to regression or disappearance of AK lesions, even in individuals with a history of significant sun exposure.