Actinic Keratoses

Actinic Keratoses
By David F. Jaffe, M.D.

Published in "PrimeTimes of Harford County," May 2000.

Question: I have had growths on my face called keratoses which my doctor told me could be cancer. What are these? Should I be concerned?

Answer: Actinic keratoses, also called solar keratoses, are sun-induced precancerous growths. They appear as red or brown, rough patches, most often on the face, neck, hands and forearms. They are the first sign of a disease continuum that can progress to squamous cell carcinoma, a skin cancer that may spread to other parts of the body and potentially lead to death.

The prevalence of actinic keratoses goes up with increasing age, from under 10 percent in the third decade of life to over 80 percent in fair-skinned persons aged 60 to 69. They occur 10 to 15 percent more frequently in men than in women. The risk of an individual actinic keratosis becoming malignant during a one-year period is estimated to be 0.25 to 20 percent. The lifetime risk is believed to be higher for someone whose actinic keratoses persist. If one progresses to squamous cell carcinoma, the risk of the cancer spreading is 2 to 6 percent.

The greatest risk factor for development of actinic keratoses is long-term exposure to ultraviolet light from the sun or artificial light. Blue eyes, blond hair and fair skin or the presence of freckles since childhood also increase risk. Individuals with xeroderma pigmentosum, a disease in which the skin is extremely sensitive to ultraviolet light, and albinism, the absence or loss of pigment in the skin, eyes and hair, are medical conditions which increase the risk of actinic keratosis development.

The best prevention of actinic keratoses, as for skin cancer, is avoidance of excessive sun exposure. Actinic keratoses must be treated to prevent their potential conversion to squamous cell carcinoma of the skin, which may require more extensive treatment and may even cause death. Treatment most often involves curettage (scraping) alone or with electrodesiccation (tissue destruction by heat), or cryosurgery (tissue destruction by freezing). Other treatments include chemical peels using mild acids, chemotherapy drugs applied to the skin and laser therapy.

Medicare has recently started denying coverage for treatment of actinic keratoses, despite hard scientific evidence that they can lead to skin cancer. The American Academy of Dermatology is working hard to rectify this injustice. In the meanwhile, if you have actinic keratoses, be sure to have them treated, regardless of what your insurance carrier says, as the risk of skin cancer from actinic keratoses is real.

Dr. David F. Jaffe is a board-certified dermatologist. He is on the clinical faculty in the Department of Dermatology at the University of Maryland and at the Baltimore Veterans Administration Hospital. Dr. Jaffe is the state medical society’s spokesperson for the Maryland Skin Cancer Coalition as well as the president of the Harford County Medical Association. He is active in civic and community affairs and has an office practice in Havre de Grace.