“Harmless” AK Precursor to Skin Cancer
Dr. Charles E. Crutchfield, III discusses actinic keratosis
Last year, fifty-eight million Americans were treated actinic keratosis (AK). Although the condition itself is not cancerous, if left untreated, AK usually results in squamous cell carcinoma. Given that “cancer” is a general term used to describe diseases characterized by abnormal changes in cells, actinic keratoses are usually included in descriptions of non-melanoma skin cancers.
We asked Charles E. Crutchfield III, MD, clinical professor of dermatology at the University of Minnesota Medical School and medical advisor for Perfect Skin Protection, to explain the condition and its treatment.
Q: What causes actinic keratosis?
A: First, you should remember that many
factors contribute to these skin
cancers: exposure to artificial UVR from
tanning beds; heredity; prolonged Q suppression of the immune system; exposure to X-rays; prolonged contact with coal, tar, pitch, or arsenic compounds; complications from burns, scars, vaccinations; and, even tattoos.
However, the overriding factor that both causes and compounds actinic keratosis is exposure to the harmful rays of the sun.
Q: Who is most likely to develop actinic keratosis
A: Actinic keratoses are generally seen on older, fair-skinned people who have been chronically exposed to the sun. They appear most often on skin least often covered by clothing – the hands, face, tip of ears, scalp and forearms. They can form in patients of all skin colors.
Q What are the symptoms?
A: Actinic keratoses are small bumps with rough, scaly surfaces or sores. They can be as small as the tip of a pencil or as large as a quarter. A person can have one or several at the same time. Some older patients find that they must be treated periodically for these lesions over many years. If this happens, your physician will carefully monitor the lesions and recommend different treatments accordingly.
Most of the patients I see with actinic keratosis are age 50 and older, but I have seen some patients even in their 20’s with the lesions.
Q: How is actinic keratosis diagnosed?
A: Diagnosis is usually easy because the lesions have unique physical characteristics that physicians can identify by visual examination.
Occasionally, if the lesion is especially large or thick, it will need to be surgically removed
for microscopic examination (biopsy) to determine if it has evolved or changed to cancer. If cancerous, actinic keratosis will likely be diagnosed as squamous cell carcinoma.
Q: How is it treated?
A: Once the diagnosis is made, dermatologists will consider a number of factors before choosing the most appropriate methods of treatment. Some of these factors include
- Location, size and number of lesions;
- The desired cosmetic outcome;
- The patient’s age, health and medical history;
- The patient’s ability to comply with treatment; and,
- The patient’s history of previous treatments.
If diagnosed in the early stages, actinic keratosis can be removed by cryotherapy or freezing; surgical excision or curettage (scraping); by applying cream (5-FU, Solaraze or Carac); or by chemical peeling, laser surgery, or other dermatologic surgical procedures.It is not usually a difficult condition to treat, but can and will spread, if left untreated.
Q How can actinic keratosis be prevented?
A: Actinic keratosis can be prevented by practicing sun protection early and throughout life. Outdoor workers, gardeners, people who live in sunny states and anyone else who is chronically exposed to the sun should be very aware of this condition. Since it is often cited as one of the most common reasons to visit a dermatologist, it is probably one of the more notable drains on Medicare and other insurance. Education about prevention and detection should eventually lower the number of people with this disease.
As I mentioned, actinic keratosis is a pre- cancer that progresses into cancer if left untreated. About five percent of actinic keratoses, left untreated, will transform into skin cancer. Having it treated and removed is vitally important to the prevention of cancer. If you develop any of the symptoms described above, see your dermatologist.
Crutchfield Dermatology serves patients in the St. Paul, Minneapolis, Eagan and surrounding areas.
He is the recipient of numerous awards and recognitions and is medical advisor for Perfect Skin Protection magazine.
He can be contacted at