Actinic keratosis

For the last years ten years or so I've had a reddish spot on my cheekbone under my left eye. One morning I woke up and was washing my face when I noticed that the reddish spot seemed to have a grid mark on it - just like the blankets that I had recently started to use - you know those cotton thermal blankets that they use in hospitals with the wide weave which are lighter and more comfy than heavy woollen blankets.

"Ah hah!" I thought; "so that's what that red spot is. It's the blanket." I sleep mostly on my left side and I figured that I somehow kept pulling the blanket up under my face and it kept leaving an impression on my skin.

Not quite. The reddish spot came and went but, a few months ago, it started to become permanent and turned dry and flaky and then, I noticed that a similar reddish spot was developing on my right cheekbone. That's when I realized that I may have actinic keratosis (AK.) So I started researching what treatments were available. Until recently there were no treatments and many elderly folks had AK spots on their faces and scalps.

AK should not be confused with seborrheic keratosis (or "Barnacles on the Skin"):

Benign lesions that don't ever turn into cancer, seborrheic keratoses, or Seb K's for short, can look dangerous. In reality they are just annoying. Also irreverently called barnacles, they come in all different shapes and sizes from large black growths to barely noticeable raised areas.

The wicked witch with a wart on her nose probably had a Seb K not a wart. So how can you tell if that bump on your face or chest is actually a Seb K? They do have some defining characteristics.

They are classically described as looking like someone took clay or a blob of dirt and "stuck" it on the skin. The edge of the seborrheic keratosis is not attached to the underlying skin making it appear that it could be removed by picking it off with your fingernail. This is because seborrheic keratoses arise from the epidermis, or top layer of skin. They don't extend deep into the skin like warts. What you see is what you get.

I developed two small brown spots on my shoulders a few years ago and went to a dermatologist thinking that they may be AK but was assured that I was simply turning into a witch getting old and ugly and had Seb K aka "barnacles." Unlike Seb K, AK, can turn into skin cancer.

Skin cancer is the most common form of cancer in the U.S., with over one million new cases diagnosed every year. Left untreated, skin cancers can be very dangerous, but with early detection — and intervention — most are curable.

Actinic keratosis (AK), also known as solar keratosis, by far the most common precancer, is the result of prolonged exposure to sunlight. It is a small crusty or scaly bump or horn that arises on or beneath the skin surface. The base may be light or dark, tan, pink, red, or a combination of these ... or the same color as your skin. The scale or crust is horny, dry and rough, and is often recognized by touch rather than sight. Occasionally it itches or produces a pricking or tender sensation. It can also become inflamed and surrounded by redness. In rare instances, actinic keratoses can bleed.

The skin abnormality or lesion develops slowly and usually reaches a size from an eighth to a quarter of an inch (2mm to 4mm) but can sometimes be as large as one inch. Early on, it may disappear only to reappear later. It is not unusual to see several AKs at a time. AKs are most likely to appear on the face, lips, ears, scalp, neck, backs of the hands and forearms, shoulders and back — the parts of the body most often exposed to sunshine. The growths may be flat and pink or raised and rough.

Actinic keratoses can be the first step leading to squamous cell carcinoma (SCC). Some studies show that ten percent do advance, and 40-60 percent of SCCS begin as untreated AKs.

Squamous cell carcinoma (SCC) is the second most common form of skin cancer, with over 250,000 new cases per year estimated in the United States. It arises in the squamous cells that compose most of the upper layer of the skin. Most SCCs are not serious. When identified early and treated promptly, the future is bright.

Basal cell carcinoma (BCC) is the most common form of cancer, with about a million new cases estimated in the U.S. each year.

Until recently many old folks had some form of AK (or even SCC and BCC) and did nothing about it. Now there are many treatments including a topical cream.

3M granted FDA approval for cream to treat superficial basal cell carcinoma:

16-Jul-2004

3M announced today that the U.S. Food and Drug Administration (FDA) has approved the first prescription therapy in nearly a decade for the treatment of superficial basal cell carcinoma (sBCC), a type of nonmelanoma skin cancer. Aldara(TM) (imiquimod) Cream, 5%, a topical immune response modifier, is now available to treat biopsy-confirmed, primary sBCC in adults with normal immune systems.

In March, Aldara Cream received FDA approval for the treatment of certain types of actinic keratosis (AK) (clinically typical, nonhyperkeratotic, nonhypertrophic) on the face or scalp in adults with normal immune systems. AK is a precancerous skin condition with lesions often occurring on the face or scalp. Both AK and sBCC are skin conditions caused by chronic sun exposure.

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About Superficial Basal Cell Carcinoma

According to the American Cancer Society, more than one million new cases of nonmelanoma skin cancer occur in the United States each year. Basal cell carcinoma (BCC) affects an estimated 800,000 Americans each year, and there are four types of BCC comprised of superficial, nodular, pigmented, ulcerating or sclerosing types.

Individuals with fair skin, blond or red hair and blue or green eyes, and those living in sunny climates are at the greatest risk for developing sBCC. Usually, sBCC develops on sun-exposed areas of the body. Superficial BCC can appear as red, finely wrinkled, scaly patches that occasionally have a fine, pearly border.

Common treatments for sBCC include surgical excision, cryosurgery (freezing), curettage (scraping) and electrodesiccation (burning).

About Actinic Keratosis

According to the American Academy of Dermatology, AK affects as many as 10 million Americans each year. Caused by chronic sun exposure, AK is a precancerous skin condition, which often occurs on the face and scalp.

Actinic keratosis appears as rough, red, scaly patches or crusts on the skin. AK lesions usually measure less than one quarter inch in diameter and more than 80 percent of lesions occur on the upper limbs, head and neck. Individuals with fair skin, light hair and light-colored eyes are at greatest risk for AK. Because AK is caused by cumulative sun exposure, it can take years to develop. The condition usually appears first in older people, although cases have been reported in people in their 40s.

Common AK treatments include cryotherapy (freezing), surgical excision, electrodesiccation (burning), curettage (scraping), lasers, topical chemotherapy and photodynamic therapy.

I will be going to a dermatologist to confirm my own diagnosis but I do have all the classic risk factors: I was born with blond hair which turned reddish as I got older and have green eyes and fair skin and I had dozens of really bad sunburns as a kid in sunny South Africa to the point where my skin peeled off so deeply that it even bled sometimes. I think I'll try the cream before the other more drastic treatments.