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Are Scaly, Dry Skin Spots Actually Precancers?

By Ellen Marmur, MD

This underrecognized precancer often thought of as “sunspots” frequently goes unnoticed.

We all know someone who fits the bill: fair skinned, covered in “sunspots” after having spent their younger days soaking up the sun, getting a nice bronze tan (or sunburn) while unwittingly bathing in harmful ultraviolet rays. While education around skin cancer has increased dramatically, it doesn’t help the generations of sun worshippers for whom the damage already has been done. I know because I’m a former sun worshipper who has survived skin cancer. For the people described above, proactive skin care and screening is essential.

One of the most common, but also most unknown, precancers of the skin is actinic keratosis (AK). When I ask people whether they know what it is, I usually get the response, “I’ve never heard of it.” This is somewhat alarming given the fact that these precancerous spots are the third most frequently diagnosed skin problem, affecting more than 58 million Americans.

As a dermatologist, I am proud of and happy about the education regarding melanoma and skin cancer protection. However, education regarding the treatment of precancers, such as AK, is still lacking. It’s important because despite the fact that most AKs remain benign, approximately 5% to 10% develop into squamous cell carcinoma within roughly two years.1

So what is AK? It’s a precancerous skin condition often mistaken for sunspots and typically is diagnosed in older adults. AK is the result of years of cumulative sun damage and most prevalent in people who have spent a lot of time in the sun over the course of their lives.

AK most often appears on parts of the body regularly exposed to sunlight, such as the face, scalp, ears, neck, hands, and arms. It’s also more common in people with fair skin.

AK is characterized by dry, scaly, rough-textured patches on the skin that can range in color and vary in size. It’s not typical for the sun to affect only small patches of the skin. Therefore, people who are diagnosed with AK usually will develop more spots over time.

Since there is no way to know which AK spots will become cancerous, it’s important to seek care from a dermatologist, as frequent skin examinations are the key to early detection and prevention, especially if patients suspect they have AK.

AK treatment options including the following:

Photodynamic therapy: This involves applying a photosensitizing agent to the AK. The treated area is exposed to a light that activates the agent. The period between application and exposure varies depending on the photosensitizing agent used. This treatment targets only the AK and causes little damage to the surrounding normal tissue. Some redness, swelling, and a burning sensation often occur during therapy.

Cryotherapy: Liquid nitrogen is used to freeze the spots, with no cutting or anesthesia required. This method causes the lesion(s) to shrink or become crusted and then fall off. After treatment there may be temporary redness and swelling. In some patients, this treatment can cause permanent white spots on the skin.

Topical medication: This involves applying a topical medication to the affected skin. The course of treatment can range from days to weeks, depending on the topical medication used. Redness, swelling, and ulceration may occur during treatment.

Curettage: This procedure uses a curette to scrape off damaged cells. A local anesthetic is required. Scarring and skin discoloration may occur at the treatment site.

Chemical peel: Chemicals are applied directly to the affected areas, causing the top layer of skin to slough off. This layer of skin usually is replaced within seven days. Anesthesia is necessary for this procedure, and temporary discoloration and irritation can occur.

Dermabrasion: This procedure involves using a rapidly moving brush to remove the affected skin. Local anesthesia is used. Following the procedure, the skin appears red and raw. It can take several months for the treated area to heal.

Surgical excision: With surgical excision, the entire lesion plus some healthy tissue is removed. Scarring is possible.

Lasers: This treatment involves focusing a laser on the lesion, cutting through the skin tissue without causing bleeding. Local anesthesia may be required. This treatment can cause pigment loss in the skin.

As always, it’s imperative for patients to consult a dermatologist if they believe they have AK. More information is available at www.spotsigns.com. This site has various educational tools including a list of signs, prevention advice, and treatment options. It can even help someone find a dermatologist.

— Ellen Marmur, MD, is an associate professor in the dermatology and the genetics and genomic research departments at Mount Sinai Medical Center in New York City.

1. Fuchs A, Marmur E. The kinetics of skin cancer: Progression of actinic keratosis to squamous cell carcinoma. Dermatol Surg. 2007;33(9):1099-1101.