Actinic Keratosis – Dry Scaly Skin Spots Common for
Seniors – Can Lead to Cancer
For up to 10 percent of people, AKs – off-color skin
blemishes often referred to as “sun spots” - will progress to squamous
Photo of one actinic keratosis
from the website Spot the Signs. See more below
March 19, 2013 - We all know someone who fits the
bill: fair-skinned, covered in “sun spots” after having spent their
younger days soaking up the sun, getting a nice bronze tan (or sunburn)
while unwittingly bathing themselves in the sun’s harmful UV rays. While
education around skin cancer has increased dramatically, it doesn’t help
the generations of sun-worshippers for whom the damage has already been
done. I know, because I am an ex sun worshipper who has survived skin
cancer. For these people, proactive skin care and screening is
One of the most common, but also most unknown
pre-cancers of the skin, is actinic keratosis (AK). When I ask people if
they know what actinic keratosis is, I often get the same exact answer,
“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 upwards of 58 million Americans.
As a dermatologist, I am proud of and happy about
all of the education we have seen around melanoma and skin cancer
protection. However, one area where we have not seen enough education is
the treatment of pre-cancers such as AK. It is important because,
despite the fact that most AKs remain benign, approximately 5-10 percent
develop into squamous cell carcinoma within an average of two years.
So what are AKs? Actinic keratosis is a
precancerous skin condition that is often mistaken for sun spots and is
typically diagnosed in older adults. AKs are the result of years of
cumulative sun damage and are most prevalent in older adults who have
spent a lot of time in the sun over the course of their lives.
AKs generally begin as rough spots of skin that may
be easier felt than seen. Common complaints include a lesion that has
increased in size or one that is raised, bleeding, poor in healing,
discolored or associated with discomfort such as pain or itching.
While a lesion may initially appear skin-colored to
pink, red, or brown, lesions on darker skin may be more pigmented. AKs
may feel soft, rough or “gritty,” but in any case, they feel different
from the surrounding healthy skin.
Since there are many clinical variants of AKs, it
is best to consult a dermatologist if you suspect a lesion.
Dr. Marmur is working with DUSA Pharmaceuticals to
support a non-branded disease awareness campaign “Spot the Signs.” The
web site www.spotsigns.com has facts
on AKs, photos of AK lesions and commonly asked questions.
AKs most often appear on parts of the body that are
regularly exposed to sunlight such as the face, scalp, ears, neck, hands
and arms. They are also more common in people with fair skin, so if
you’re one of those people you should be on particularly high alert.
AKs are rough-textured, dry, scaly patches on the
skin that can range in color and vary in size. It is not typical for the
sun to affect only small patches of the skin – therefore, people who are
diagnosed with an AK will typically develop more AKs. So while there may
be one AK on the surface, there may be more nascent AKs that will
present over time.
Since there is no way to know ahead of time which
AKs will become cancerous, it is very important to seek
a dermatologist’s care. Don’t ignore your sun spots! Frequent skin
examinations are the key to early detection and prevention. If you think
you have AKs you should see your dermatologist and talk about the best
There are many treatment options available, and you
should discuss which is best for you with your dermatologist. These
Photodynamic Therapy This treatment involves the application of a photosensitizing agent
to the AKs. The treated area is exposed to a light that activates the
agent. The period between application and exposure will vary and depend
on the photosensitizing agent that is used. This treatment targets just
the AKs and causes little damage to the surrounding normal tissue. Some
redness, swelling and a burning sensation during therapy often occurs.
Cryotherapy (freezing) This treatment involves freezing the AKs with an extremely cold
substance such as liquid nitrogen. There is 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 treatment involves the application of a topical medication to
the affected skin. The course of treatment can range from days to weeks,
depending on the topical medication that is used. Redness, swelling and
ulceration may occur during treatment.
Curettage (scraping) This procedure involves the use of a curette to scrape off cells
that are damaged. A local anesthetic is required for this procedure.
Scarring and skin discoloration may occur at the site of the treatment.
Chemical Peel Chemicals are applied directly to the AKs. The chemical causes the
top layer of skin to slough off. This layer of skin is usually 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-looking. It can take as long as several months
for the treated area to heal.
Surgical Excision With surgical excision, the entire lesion with some healthy tissue
is removed. Scarring is possible with this procedure.
Lasers This treatment involves focusing a laser on the lesion. The laser
cuts through the skin tissue without causing bleeding. Local anesthesia
may be required. This treatment can cause pigment loss in the skin.
As always, it is imperative to talk to your
dermatologist if you think you have AKs, but if you’d like to learn
more, please visit
This site has a variety of educational tools including a list of signs,
prevention advice, and treatment options. It can even help you find a
Fuchs A., Marmur E. The Kinetics of Skin Cancer: Progression of Actinic
Keratosis to Squamous Cell Carcinoma. Dermatol Surg. 2007:33;1099-1101.
About Dr. Ellen Marmur
Dr. Ellen Marmur is an Associate Professor of both
the Department of Dermatology and Department of Genetics & Genomic
Research, and was promoted to Vice Chair, Cosmetic and Dermatologic
Surgery in 2011 after having been the first woman Chief of Dermatologic
and Cosmetic Surgery at The Mount Sinai Medical Center in New York City
for 7 years.
A board-certified dermatologist with advanced,
fellowship training in cosmetic & laser surgery as well as Mohs skin
cancer surgery, Dr. Marmur earned her degree in medicine at Albert
Einstein College of Medicine with distinction in research on melanoma
vaccines and the Alpha Omega Alpha award for overall academic and
clinical excellence in medicine. She trained in internal medicine at
Mount Sinai School of Medicine and then in dermatology at The New
York-Presbyterian Weill Cornell Hospital in Manhattan.
completed her fellowship in Mohs Micrographic surgery & Cosmetic Surgery
with the world reknowned leader, Dr. David Goldberg. Dr. Marmur is the
principle investigator on dozens of research studies including FDA
trials on new therapies such as the safety trial using calcium
hydroxyapatite filler in dark skin types, the first in class treatment
of advanced basal cell carcinoma approved in 2012 called Erivedge, and
many new treatments for actinic keratoses. Her current interest is in
genomic and epigenetic analysis of the effects of sun exposure and aging
Dr. Marmur’s passion is to understand how healthy
skin protects against skin cancer and aging.
Member of Professional
Dr. Marmur is President of the American Society of
Cosmetic Dermatology & Aesthetic Surgery (ASCDAS), a spokesperson for
the American Academy of Dermatology, an active member of the American
Society of Dermatologic Surgery, The New York Dermatologic Society,
Women’s Dermatologic Society, American Medical Women’s Association,
American College of Mohs Micrographic Surgery and Cutaneous Oncology,
and American Society for Laser Medicine and Surgery.