Actinic Keratosis is a precancerous lesion which, if left untreated, can become squamous cell carcinoma. This is the most common diagnosis seen in adults in dermatology. Actinic keratosis is a small, scaly lesion that is found in sun exposed areas. These lesions tend to form in groups and it is not uncommon to find 10 or 15 on the backs of the hands, face or top of the scalp.
It has been proven that ultraviolet radiation from the sun causes damage to the skin cells. Once the damaged cells proliferate, they form scaly bumps known as actinic keratosis. The lesions vary in color from beige to red to pink, and patients often complain of itching or irritation at the site of an actinic keratosis. Mount Sinai dermatologists are experts in diagnosis and treatment of actinic keratosis.
Cryosurgery is the most commonly used treatment of actinic keratosis and is performed with an instrument that freezes and destroys abnormal tissue. The simplest lesion removal treatment involves the application of liquid nitrogen using a sprayer or applicator at the site. There is typically some blistering which removes the damaged cells, allowing new skin to replace it.
When there is numerous actinic keratosis, your Mount Sinai dermatologist may prescribe a topical cream to treat the visible lesions as well as the lesions under the surface. The most common topical treatment for actinic keratosis involves application of an immune modulator (stimulates local immune system) imiquimod, a topical chemotherapy know as 5 fluorouracil, or a new product called Picato. Zyclara, the brand name imiquimod, is now available in a pump – this makes the product easy to use. Picato is the newest AK treatment approved by the FDA. The treatment course with Picato is short, with 3 total applications for the face and scalp and 2 total applications for the hands, forearms and chest. Topical treatment usually produces redness of the skin, so discuss your social schedule with your dermatologist before starting this treatment. Mount Sinai has been involved in multiple studies of actinic keratosis and is currently conducting several studies. If you'd like to enroll, please contact your dermatologist or the clinical trials unit.
Blue Light (PDT)
Photodynamic blue light therapy (PDT) is a non-invasive method used to treat photo damage, precancerous lesions and other skin conditions. A special light-sensitive medication called AminoLevulinic Acid (ALA) is applied to the skin affected by actinic keratosis and allowed to remain there. Then the blue light is directed to the skin and the cells that have absorbed the medication respond. The application of ALA followed by the exposure of specific blue light causes the selective destruction of targeted cells. Many patients can achieve excellent results with a course of treatments using ALA and blue light.
Electrodesiccation & Curetage
With this method, your dermatologist uses a curette (a rounded metal object with a sharp edge) to scrape out the actinic keratosis. Electrical current is then used to burn (electrodesiccate) the base of the lesion. This process is repeated three times to obtain a margin around the actinic keratosis.