Solar Keratosis

Key Points
Consist of small pink areas of skin which are rough or scaly
Caused by chronic accumulative sun exposure
Considered a pre-cancerous condition

Actinic keratosis, also known as solar keratosis, is a precancerous condition related to damage from chronic sun exposure. Affected persons develop small pink or red lesions which are rough or scaly, usually appearing on parts of the body which are not typically covered by clothing. In some cases, squamous cell carcinoma develops within these lesions, which is the rationale for their preventative removal. Any part of the body with consistent sun exposure, most commonly the face, scalp, ears, neck, arms and top of hands, may be affected . Actinic keratoses are usually 1 centimeter or less in diameter, generally slightly scaly (with occasional instances of lesions which become thick with scale, as with warts), and with a pink, red or brown color variation.

Actinic keratoses most commonly affect fair-skinned persons, those who have trouble tanning (in other words, burn easily), those with light-colored (blue, green, hazel) eyes, and those with red or blond hair. Any person with excessive sun exposure, especially during their youth, is at greater risk. In addition, persons with weakened immune systems due to HIV, chemotherapy or organ transplant have a greater risk of developing actinic keratoses and skin cancers.

Differential Diagnosis (Other conditions with similar appearance)
Squamous cell carcinoma
Bowen’s disease (squamous cell carcinoma in situ, a very thin noninvasive type of squamous cell carcinoma)
Basal cell carcinoma
Seborrheic keratosis
Wart
Benign Lichenoid keratosis

Diagnosis
Key Points
Diagnosis based on appearance and location
Skin biopsy may be performed to rule out malignancy

Actinic keratosis is generally diagnosed based on appearance of the affected area. Health care professionals may biopsy the affected area to exclude malignancy.

Prevention is the most important factor in combating the disorder
All occurrences should be treated, as the disorder has the potential to become malignant
Several treatments exist to destroy the pre-cancerous growths. Most commonly cryosurgery (destruction by freezing with liquid nitrogen), 5-fluorouracil topically, Imiquimod cream topically, Photodynamic therapy, and chemical peel are all options to treat AK's.
*Self-examination is key in the timely recognitiont of actinic keratoses

Prevention of actinic keratosis by moderating direct sun exposure is recommended. Prevention of sun exposure has been shown to reduce the occurrence of new lesions. Covering the skin with appropriate clothing during times of sun exposure, using sunscreen with a high Sun protection factor (“SPF”) of 30 or more, seeking shade during prolonged outdoor activities (or planning outdoor activities during the morning or evening hours), and even wearing clothing with an UPF rating can assist in prevention.

If an affected area begins to change quickly or bleed, attention from a medical professional is recommended. Several options are available to treat or destroy the affected tissue, including the use of creams (fluorouracil, diclofenac, Imiquimod), cryosurgery, curettage (scraping), dermabrasion, chemical peeling, or laser treatments. Photodynamic therapy has also been shown to help in affected persons.