Actinic keratoses, commonly referred to as “pre-cancers,” are even more common than skin cancers. These pre-cancerous lesions are often on the sun-exposed skin of the face, scalp, hands, forearms and lower legs. The rims of the ears are an especially common place for men to have a pre-cancer. Patients often complain of dry rough spots that won’t go away regardless of how much moisturizer is applied. Early lesions can come and go for months until they eventually are present all the time.
Spots can “tingle” when exposed to sunlight and can be tender to the touch. Over a 10 year time frame, up to 10 percent of these pre-cancerous lesions will turn into a true skin cancer. It’s not uncommon to have several (up to 20 or more) of these lesions scattered on the face, scalp, arms and legs. Patients who have actinic keratoses are at high risk for developing true skin cancer.
How to Handle Pre-Cancers
There are several treatment options for actinic keratoses. Cryotherapy with liquid nitrogen is a very simple and quick procedure, but it only treats individual spots (not the entire face, scalp, etc.) and has the potential to heal with a white discoloration. Creams such as 5-fluorouracil and imiquimod are very effective, but patients must endure 2-4 weeks of red, crusted, sometimes painful skin.
Photodynamic Therapy – A New Pre-Cancer Treatment Option
One of the newer treatments for actinic keratoses is called photodynamic therapy. This is a completely different method for treating pre-cancers than anything offered in the past. Faces, scalps, arms or legs can be treated. The treatment area is washed and a liquid called aminolevulinic acid (ALA) is applied to the skin. The patient must then wait 1-2 hours while the ALA gets taken up into pre-cancerous cells. After the waiting period, the treatment area is exposed to a specific wavelength of light that appears blue for 16 minutes and 40 seconds. During this time, patients may feel a stinging or burning sensation. The blue light activates the ALA and the pre-cancerous cells are destroyed. After the procedure, sunscreen is applied. Because the ALA can be continually activated by sunlight for up to two days, patients must avoid sun exposure for the next 48 hours. The treated area may be red for several days and may peel similar to a sunburn after 7-10 days. After 10 days, skin is smoother and healthier, and the pre-cancerous lesions have resolved. Photodynamic therapy is covered by most insurance companies. It’s a great option and it’s available in our dermatology clinic.