Skin Cancers and the pre cancerous lesions actinic keratosis (AK) is a common lesion induced by ultraviolet light that represents the earliest manifestation of squamous cell carcinoma (SCC) of the skin.
AK often occurs during and after the midlife stage and is primarily caused by prolonged exposure to UV radiation. AKs appear on sun exposed areas such as face, ears, bald scalp, neck, back of hands, forearms and lips. AKs are well recognized as potential precursors of squamous cell carcinomas.
Skin cancer is a growing concern and widespread condition in the United States and elsewhere. In the US there are over 1 million people diagnosed with basal cell carcinoma and 50,000 people diagnosed with melanoma every year. With early detection and treatment the vast majority of skin cancers are curable with surgery alone. It is believed that practicing sun avoidance and sun protection over one's lifetime can prevent many skin cancers.
Factors that influence choice of therapies:
- Mild or severe disease
- Site of the keratoses
- Extent of the keratoses
- Density of the keratoses
- Patient immunosuppression
- Medical conditions existing with keratoses
- Patient pain tolerance'
- Cosmetic considerations
- Presence of carcinomas
Home Therapies: At Body Renewal we offer traditional twice daily topical therapies such as salicylic acids, 10 % urea cream and AHA and PHA preparations to clear mild keratoses.
Topical 5- Fluorouracil (5 FU)applied twice daily for 2 to 3 weeks can be used to treat AK s but patients can become extremely uncomfortable when the lesions erode, particularly if they have a large number of these lesions (over 100 on the face). 5 FU can worsen other conditions such as Rosacea or Melasma so these patients are better suited for in office treatment of ALA/PDT for a more long term solution to their problem. On the body especially the arms, the duration of treatment should be increased to four weeks as the keratoses in this region are slower to respond. These patients are better suited for in office treatment of ALA/PDT for a quicker, longer term solution to their problem.
Topical imiquimod or Aldara is useful to treat either a region of AKs or individual lesions. Lesional inflammation is to be expected with current protocols of 2 or 3 applications per week for 6 weeks. A second cycle can be repeated if necessary. There is no benefit from further cycles if the AK s are resistant and these patients are better suited for in office treatment of ALA/PDT for a more long term solution to their problem.
In Office Therapies:
At Body Renewal we offer the following in office therapies. As each patient's case is different; we will tailor a treatment program specifically for you and your circumstances. A highly professional team led by a medical doctor assesses every patient and an appropriate treatment together with long term maintenance program is recommended dependent on expectations, budget, time and medical conditions.
- Cryotherapy remains the current standard technique for isolated AKs. A freeze- thaw time of longer than 10 seconds but less than 15 seconds produces the best results. A downside of this therapy is the hypopigmentation present in 29 % of patients treated with longer freeze-thaw times.
- PDT/ALA A new method for treating AKs and basal cell carcinomas is PDT using ALA (amino laevulinic acid). This method appears to be effective in removing 91 % of lesions and is useful in areas where the AKs are extensive. The treatment can be repeated and the cosmetic effect is far superior to that achieved with cryotherapy. PDT/ALA is advantageous in patients with large and or multiple lesions in sites where disfigurement or poor healing from conventional therapies is a particular risk. PDT/ALA produces significant improvement in patients with AKs but downtime of a week can be expected. Remission can last form 1 to 2 years. An added benefit is skin rejuvenation.
- Chemical peels. The more aggressive the chemical peel, the more improvement one can expect. Medium depth chemical peels produces significant improvement in patients with AKs but downtime of a week can be expected. This improvement should last for 2 to 3 years. An added benefit is pigmentation improvement and skin rejuvenation.
Hyperkeratotic lesions not due to keratin and lesions not responding to treatment may indicate squamous cell carcinoma and these patients are referred to dermatologists for further evaluation and treatment.