How do I identify and treat benign and malignant actinic keratosis?

Doctor's Answer

Actinic keratosis commonly presents as a scaly papule or a small rough scaly patch, commonly on sun-exposed areas. The scales are typically described as adherent and are difficult to peel off. As the name 'actinic' suggests, this is due to excessive cumulative sun exposure throughout one's lifetime.

Actinic keratosis is considered a pre-malignant lesion. Actinic keratosis is not cancerous but has the potential to develop into squamous cell carcinoma, which is a form of skin cancer. Therefore it is important to treat actinic keratosis to prevent them from developing into skin cancer.

Firstly, I must stress the importance of sun protection to prevent the development of actinic keratoses. This should be started from childhood as the damage to the skin from sun exposure is cumulative.

There are various ways to treat actinic keratoses. One commonly employed treatment is liquid nitrogen treatment or cryotherapy, where the actinic keratosis is frozen off. Actinic keratosis can also be treated by electrosurgical ablation. Topicals creams like imiquimod and 5-fluorouracil (5-FU) can also be used. A newer treatment option called photodynamic therapy is also approved for the treatment of actinic keratosis.

Sometimes, a skin biopsy may be needed to confirm the diagnosis of actinic keratosis and to rule out its progression to a squamous cell carcinoma.

If in doubt, do see your doctor or dermatologist to confirm the diagnosis and discuss about the different treatment options.

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