ACTINIC KERATOSIS

WHAT TO EXPECT

What are actinic keratoses?

They are areas of sun damage found on sun exposed skin such as on the forehead, scalp, ears, lips, back of hands and forearms. They have the appearance of pink rough scaly patches, sometimes with crusting. There is a small chance of progression to skin cancer called squamous cell carcinoma (lesion becomes lumpy, tender or bleeds), therefore treatment is suggested.

What is the cause?

Long term cumulative sun exposure over the years?

What is the treatment?

An initial consultation is required for confirmation of the diagnosis, either by skin examination (commonly), or by a skin biopsy (If in doubt or if there are changes suggestive of a skin cancer); followed by a discussion of the treatment options.

Options offered in our clinic include:

i) creams – 5-fluorouracil, imiquimod or Ingenol mebutate gel can be prescribed for application at home for durations varying between 2 days and 6 weeks. They act by causing some inflammation such as redness, soreness, and crusting, which eventually settled after treatment.

ii) cryotherapy – it involves freezing with liquid nitrogen. It can be performed in the clinic, and may require a few repeat sessions. Treatment can be slightly painful, followed by swelling, redness, blister and scab formation, and eventual clearance. There is a small risk of pigmentary changes and scarring.

iii) curettage and cautery – this is surgically scraping off the lesion under local anaesthesia, which can leave a scar. It is recommended if the diagnosis needs to be confirmed by testing the sample or if the lesion is crusty and may not be amenable to creams.