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Sun-Induced Precancers: Actinic Keratoses

Originally Posted: May 24, 2010

Kara Veit Meyers, PA-C

Close-Up of Actinic Keratoses on arm. (actinic-keratosis.info)

Southampton - As we get older and our faces mature, many of us find ourselves looking into the mirror wondering what the different spots are.

While most of these spots are benign, others may be precancerous lesions, called Actinic Keratoses (AK). The name literally means what they are: actinic means sunlight and keratoses means thick scaly growth. Actinic Keratoses is a result of long-term ultraviolet radiation (UV) damage to the skin that induces DNA changes in the cells of the epidermis.

They appear as reddish rough scaly lesions that feel like sandpaper. Usually, Actinic Keratoses occur on fair-skinned individuals and tend to favor the face, ears, and bald scalp. However, they can occur on anyone and on different areas of the body. They are very common and there is seldom just one lesion. Although some of them may regress or persist unchanged, approximately 10 percent may progress to a skin cancer called, Squamous Cell Carcinoma. In order to prevent this, it is recommended that they are treated.

There are numerous treatments for Actinic Keratoses, such as topical creams and a freezing spray called, Liquid Nitrogen. However, if you want fast optimal treatment, Photodynamic therapy (PDT) should be considered.

Photodynamic Therapy is a treatment that uses a light source, such as the BLU-U light, along with a photosensitizing drug, called aminolevulinic acid (ALA or Levulan). Used together, they destroy the abnormal cells. This happens by applying Levulan directly to the skin and allowing it to be absorbed into the damaged cells for a certain time period. Thereafter, the area is exposed to the BLU-U light where a reaction takes place and the premalignant cells are killed. Your unaffected skin will not be impaired.

Photodynamic therapy is a two part treatment that takes approximately two hours in the office. After you are brought back into the treatment room, your face or scalp will be cleansed. The Levulan will then be applied to your Actinic Keratoses lesions or to the entire face or scalp. At that time, you will be asked to wait in the waiting room for about one hour. Next, you will come back into the treatment room and sit in front of the BLU-U light with eye protection for just about 17 minutes. While in the BLU-U light you might experience a tingling or burning sensation that is completely normal. This sensation tends to level off after the first two to three minutes and is normally well tolerated. Thereafter, the levulan will be rinsed off and complete care instructions will be given.

There are certain recommendations and precautions that you should be aware of prior to this treatment.

 • We recommend that you bring a hat or umbrella with you to use after treatment to avoid sun exposure.

 • After the treatment you will be asked to avoid sun exposure for 48 hours. This includes bright light and sitting by windows.

 • It is also recommended that you consider staying home the day after your treatment due to the side effects you may experience. Some side effects include, but are not limited to redness, scaling/crusting, peeling, burning sensation, skin discoloration, and possibly swelling. These side effects usually occur during the first two days and will resolve over the following week or two.

 • You may use gentle cleansers and moisturizers as often as you feel necessary.

Photodynamic Therapy can be used as maintenance therapy or it may be recommended more than once. The result though is a large amount of your skin will be free of premalignant Actinic Keratoses. This treatment is a "field effect" way of treating actinic keratoses rather than traditional "spot effect" treatment. Your skin will most likely have an improved appearance and a smoother texture. If you would like to know more about this treatment please contact us at the number provided. It is covered by insurance companies.

Kara Veit Meyers, PA-C, Hampton Dermatology, 325 Meetinghouse Lane, Suite J, Southampton, 631-283-3131.

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