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Actinic Keratosis: FAQ

What are actinic keratosis?

Actinic keratosis (AK), sometimes called solar keratosis, is a scaly or crusty patch of skin that occurs on parts of the body that have been overexposed to the sun. It is a very prevalent condition with up to 50% of people over the age of 40 having at least one AK lesion. It is more commonly found in those with fair skin, and is more common in the elderly as they have had more time to accumulate exposure. Although the condition is painless, it can be tender to the touch. Actinic keratosis is considered to be a precancerous condition, meaning that it can potentially become a cancerous lesion if left untreated.

  • Crusty, or scaly patches that can be tender, and felt through touch
  • Most common in those with fair skin, have been exposed to the sun, and are over the age of 4
  • Rarely painful, sometimes itchy after sun exposure
  • Sign of accumulated sun damage over the years
  • Precancerous lesion that should be removed as soon as possible

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How do I know if I have actinic keratosis?

Actinic keratosis can often be identified by the patient through touch in its early stages. They feel like hard and rough scaly patches of skin. The growth of skin is usually small, between the size of a pencil point, and a pencil eraser (2-5mm in diameter), with a rough texture, and can vary in color from skin color to red. The top layer is usually crusty with a yellowish scaling. Actinic keratosis is a sign of severe sun damage, and thus is often seen in close proximity to other signs of sun damage on the skin, such as discoloration, wrinkling, and superficial blood vessels. In some cases, the actinic keratosis may be mildly painful when it rubs against clothing. As presentations can vary, it may help you to view the images of AK from the slide below. If you suspect that you may have actinic keratosis, we strongly recommend that you visit a dermatologist for a proper diagnosis.

  • In its early stages, actinic keratosis can often be felt as hard rough scaly patches.
  • Actinic keratosis can be recognized visually with relative ease. Visit a doctor if you are unsure, and they can conduct further tests.
  • Often in areas of the body that are showing other signs of sun damage, such as wrinkling, discoloration, and broken blood vessels.
  • Actinic keratosis is generally painless
  • Use the images from the slides below for reference

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Who is at risk?

Unfortunately, anyone who has had exposure to sunlight is a possible candidate for developing actinic keratosis. Actinic keratosis is most commonly found in the elderly population who have spent many hours outdoors where they are exposed to the sun. Those with fair-coloured skin are generally more vulnerable, as are patients who are immunosuppressed from certain medications. Those who are already showing other signs of sun damage such as mottled skin, Hyperpigmentation, wrinkling, and discoloration should be careful about actinic keratosis.

  • Patients with compromised immune systems.
  • Common possible causes include illnesses that weaken the immune system such as AIDS or transplant patients, or those on medication that modify or otherwise modify or suppress the immune system
  • Those with fair coloured skin are at higher risk, as well as patients who are older
  • Those with a past history of actinic keratosis or skin cancer are at higher risks, either due to natural susceptibility or due to their accumulated sun damage

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What part of the body is most commonly affected?

The face, scalp, and the back of the neck are the most common sites, as they are typically areas where clothes do not cover the skin from sun exposure. The chest, forearms, and the top side of the hands are other areas that are commonly affected. For women, the lower legs are common sites where actinic keratosis present. When present on the scalp, they often present as small red bumps or tan crusts.

  • Face and neck, as they are the least covered areas of the body and most likely to accumulate sun damage. These lesions are often red to brown in color.
  • Chest, forearms, and the top side of the hands are other areas that commonly develop actinic keratosis.
  • For women, the lower legs are a common site for actinic keratosis.
  • The scalp is also a common site for those who shave or are bald as the hair serves to protect the scalp. When present on the scalp, they often present as small red bumps or tan crusts.

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Is it true that actinic keratosis is a kind of cancer?

Actinic keratosis is not cancer. They are, however, precancerous lesions, meaning that they can develop later into skin cancer, in this case, a cancer called Squamous Cell Carcinoma, which has the potential to spread into internal organs. While the chances of malignant changes occurring are relatively low, there is no reliable method that predicts which ones will become cancerous later. For this reason, it is strongly recommended that actinic keratosis be properly treated.

  • Actinic Keratosis is not cancer. While it is an actinic keratosis, it will not spread to other parts of the body through metastasis.
  • While the chances of an individual actinic keratosis lesion progressing into skin cancer is very low, there is no method to accurately predict which actinic keratoses will later become cancer, and thus, it is recommended that all cases of AK development be taken seriously
  • It is strongly advised that actinic keratoses are removed as a certain percentage of them will later develop into squamous cell carcinoma, a type of skin cancer.

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How is actinic keratosis diagnosed?

Doctors, in most cases, can visually diagnose actinic keratosis. A biopsy will then confirm the diagnosis, and to rule out the possibility of invasion into the dermis, which is then called Squamous Cell Carcinoma.

  • Doctors can diagnose by sight and touch in most cases.
  • A biopsy is used to confirm the diagnosis.
  • Biopsy is necessary to ensure that the actinic keratosis has not progressed into skin cancer.

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What is actinic chelitis?

Actinic chelitis is a type of actinic keratosis that affects the outer border of the lower lips. As it advances the lips often become discoloured at the border of the lip and skin, becoming scaly and elevated. Like other forms of AK, actinic chelitis is caused by chronic overexposure to sunlight. Typically, elderly males with light coloured skin are at the highest risk of developing this disorder. Actinic chelitis has a much higher chance of changing into skin cancer, compared to other forms of actinic keratosis. It is estimated that up to 1 in 5 cases of actinic chelitis, left untreated, will progress to squamous cell carcinoma, a much higher rate than other forms of actinic keratosis. For this reason, actinic chelitis should be taken seriously, and treated as soon as possible.

  • Actinic chelitis is a type of AK that affects the border of the lips.
  • Actinic chelitis has a high rate, up to 20%, of turning into a skin cancer, and therefore should be treated immediately.
  • The first sign of actinic chelitis is a discoloration at the outer border of the lips.

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I haven't tanned in years! How is it possible that I have actinic keratosis?

Actinic keratosis is a disorder that can take many years from the initial sun damage that induced the disorder to fully develop. Sun damage is also cumulative, meaning that every time you expose yourself to the sun, you accumulate some amount of sun damage. Unfortunately, this means that bad sun habits can come to haunt you in later years, even if you have since done well to protect yourself from the sun. Finally, while sun damage is the main factor, there may be other factors such as the immune system quality, smoking, stress, and chronic inflammation that affect a person's likelihood of developing this condition.

  • Actinic keratosis can take years to develop after the initial lesion causing damage has been done. AKs can present as a response to sun damage from long ago.
  • Actinic keratosis is influenced mainly by sun exposure, however, other factors such as genetic predisposition and factors that influence immune health such as smoking, alcohol, and other lifestyle factors, can also influence it

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What may look like actinic keratosis?

  • Seborrheic Keratosis-when irritated or scratched
  • Basal Cell Carcinoma or Squamous Cell Carcinoma-These skin cancers may present similarly to AK at times.
  • Warts-Common warts may present in similar ways
  • Hypertrophic actinic keratosis-Thickened red scaly lesion

If pigmented

  • Lentigo maligna
  • Melanoma in situ
  • Pigmented basal cell cancer

Understand that like many skin conditions, actinic keratoses can vary in presentation, from area to area, and from person to person. The hints here are dry and scaly lesions that persist, and are on sun exposed areas. If unsure, visit a doctor who can refer you to a dermatologist for confirmation. Even if it turns out to be another benign lesion, you can rest comfortable knowing it.

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Will insurance cover my treatment?

Insurance policies will vary individually. Treatment of actinic keratosis is considered in most cases to be a medical treatment, although there will surely be an aesthetic benefit to its removal.

  • Insurance varies on depending on the individual policy.
  • Actinic Keratosis treatment is considered to be a medical treatment although its removal will also have aesthetic benefits.

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Should I get my elderly parent (relative/friend) to visit a clinic?

Yes. Urge your father to visit a clinic. The diagnosis and treatment should be relatively simple, however, actinic keratosis is a medical issue as it indicates skin damage, and can potentially lead to skin cancer if left untreated.

While many people have a strong fear of cancer due to losing people close to them to cancer, the connection between actinic keratosis and skin cancer is not so well known. For many people in the older generation, the sight of actinic keratosis is a common and familiar one that is associated simply with general aging. Remember that actinic keratosis is an extremely prevalent condition that affects up to 50% of the population by the age of 70.

It is imperative that the patient understands that while very prevalent, actinic keratosis has a very real potential to develop into skin cancer, and is a sign that the skin damage has reached a critical mass, and is vulnerable to other skin problems, including skin cancers that are not associated with actinic keratosis.

If you have a loved one who has actinic keratosis, encourage them to visit a clinic. There are many treatment options available, most of which are relatively simple, convenient, and non-invasive.

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But the chances of each AK becoming cancerous is low, is it not?

Studies show that actinic keratosis can progress to squamous cell carcinoma anywhere from .25% to 16% per year. The wide spread is likely due to the individual difference in AKs which are more dangerous and ones which are less so. Whether you interpret this figure to be high or low, it is important to note that these are the figures for a single AK lesion. If you have multiple AK present as many do, the risk increases proportionately. Secondly, AK is not only a condition, but it is also a symptom. It signifies extensive sun damage, which is a danger sign for developing more AKs or skin cancer in the area.

A more accurate way to look at it is that AK is a sign that the body has taken extensive sun damage, and is now displaying warning signs. It is important that you take care of your body now, to both treat the existing AK, and to do everything to prevent future skin problems from arising. The first priority is to avoid the sun as much as possible going forward. During treatment it is advised that you avoid sun exposure.

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Related video playlist: Sun Damage and Skin Cancer

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