|By David F.
"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
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.