Actinic Keratoses and Skin Cancer

Dermatology Nursing. 2002;14(6) 

Introduction

What Are Actinic Keratoses? Actinic keratoses (AKs) are a common skin condition characterized by rough, red, scaly patches, crusts, or sores on the top layer of skin (see Figures 1 & 2). If left untreated, they can progress to a type of invasive skin cancer called squamous cell carcinoma, which can be fatal (see Table 1 ).

Actinic keratoses usually appear as rough, red, scaly patches, crusts, or sores on the top layer of the skin. Reprinted with permission from the American Academy of Dermatology.

Actinic keratoses on the back of a hand. Reprinted with permission from the American Academy of Dermatology.

Who Gets Actinic Keratoses? AKs affect more than five million Americans. Because AKs take years to develop, their incidence increases as people age. Fair-skinned people living in sunny climates and those with poor immune systems (for example, people who have received organ transplants or those with HIV) are more prone to developing AKs and skin cancer.

What Causes Actinic Keratoses? It is believed that genetics and cumulative sun exposure are the main determinants for AKs. People with fair skin, light hair, and light-colored eyes are thought to be most "sun sensitive," and at greatest risk. Individuals with a history of extensive sun exposure, and those who work or spend a lot of time outdoors through sports or recreational activities have a greater chance of developing AKs.

Where Are Actinic Keratoses Usually Found? AKs usually develop on the face, lips, ears, scalp, neck, forearms, and back of the hands. These are the areas most commonly exposed to sun.

Are Actinic Keratoses Deadly? AKs may be an early sign of squamous cell carcinoma, the second leading cause of skin cancer deaths in the United States. In fact, at least 40% of all squamous cell carcinomas begin as AKs. If caught early, AKs are curable. But if they progress to squamous cell carcinoma and are left untreated, the cancer can metastasize, which can be deadly.

How Are Actinic Keratoses Treated? Fortunately, various treatments are available for AKs. The course of treatment depends on the nature of the lesion, age, and overall health of the patient. Common treatments include:

  • Surgical removal

  • Cryosurgery

  • Electrodessication

  • Topical medications

  • Patient-administered cream that triggers an immune response

  • Lasers, chemical peels, and dermabrasion

The American Academy of Dermatology is dedicated to achieving the highest quality of dermatologic care for everyone. For more information about AAD, please visit http://www.aad.org.

Is Treatment for Actinic Keratoses Covered by Insurance? Recognition of AKs as a potentially serious skin condition among insurers is increasing. In fact, on July 20, 2001, the Centers for Medicare & Medicaid services (formerly known as the Health Care Financing Administration) announced its decision to include a new national coverage policy on the treatment of AKs in the Medicare Coverage Issues Manual. The national policy provides coverage for treating AKs, without restriction, based on the nature of the lesion or patient characteristics, using a range of surgical and medical methods. The policy, which will affect some 39 million Medicare recipients, will help ensure the best outcomes for patients with AKs.

Can Actinic Keratoses Be Prevented? While preventing AKs and skin cancer should begin in early childhood, it is never too late to adopt safe sun practices. The American Academy of Dermatology recommends a comprehensive sun-protection program that includes:

  • Seeking shade whenever possible.

  • Staying out of the sun when the sun's ultraviolet rays are the strongest - between 10 am and 4 pm.

  • Using a broad-spectrum sunscreen with SPF of 15 or higher, and applying it frequently.

  • Wearing wide-brimmed hat and protective clothing.

  • Discouraging sun tanning - in the sun or in a tanning salon.

  • Protecting children - babies under the age of 6 months should be out of the sun. Sunscreen should be used on babies over 6 months old.

  • Performing regular skin exams and consulting a physician if a suspicious area is found.

Sources: Skin Cancer Foundation, American Academy of Dermatology, and American Cancer Society

Where Can Someone Get More Information about Actinic Keratoses and Skin Cancer? For more information about actinic keratoses and skin cancer, contact the American Academy of Dermatology through its toll-free number, (888) 462-DERM (3376), or through the organization's web site, http://www.aad.org.

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