ACTINIC KERATOSES CAN LEAD TO SKIN CANCER IF NOT TREATED

Question: I have noticed these rough patches on my forehead since doing yard work this spring. I went to the doctor and he said I have an actinic keratosis and gave me some cream for it. Could you tell me more about this condition?

Answer: Actinic keratoses are skin lesions that occur in up to 25 percent of the population in the northern hemisphere. They are a direct result of ultraviolet radiation and are more common in fair-skinned people as well as those who have a long history of sunbathing and/or not using sunscreens. These lesions are also often seen in those whose jobs require them to work outdoors.

It’s good that you are having these actinic keratosis lesions treated. This is because they are classified as “premalignant” and can become cancerous if left untreated. The kind of cancer they develop into is called squamous cell carcinoma. It’s one of three major types of skin cancer. While not as likely to kill as melanoma, squamous cell carcinoma is more dangerous than basal cell carcinoma, which is the most common type of skin cancer.

Actinic Keratoses commonly “show up” in the spring or summer, leading physicians to believe that they become more active after sun exposure. By show up, I mean that this is when the patient is most likely to notice the skin blemish and the doctor to diagnose it. Most commonly these blemishes are found on the face, the back of the hands and the forearms. They feel like a rough patch on the skin and can be red and scaly. There can be one lesion or several.

A physician can usually recognize this lesion and frequently does not need to do a biopsy to make the diagnosis. Several different types of creams and ointments are used to treat these lesions. They can also be removed by freezing them a couple of times using a technique called cryotherapy.

After your lesions have been taken care of, your primary goal should be to not get anymore. We are realizing now that sun exposure when we are young causes lifetime damage to the skin. We cannot turn back the clock, but we can move forward, wearing protective clothing when out in the sun and using a sunblock with a high sun protection factor, or SPF. In general that SPF number should be 15 or higher. On any day that you are anticipating sun exposure, you should apply sunblock in the morning before you go outside. Don’t forget to use sunblock on your lips, and if your hair is thinning, on your scalp.

Using these preventive techniques can help you avoid another round of actinic keratosis. The same measures -- if started early enough in life -- can also protect against other forms of skin cancer, including the dangerous melanoma variety. Also, taking these common sense steps to reduce sun exposure will set a good example for our children and grandchildren. If they follow our example, their generation will see many less cases of precancerous and cancerous skin lesions.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at http://www.FamilyMedicineNews.org.