What are actinic/solar keratoses?

Actinic/Solar keratoses are pre-cancerous lesions that develop on sun-exposed areas of skin. They most commonly appear as rough, dry and scaly patches on the skin.

Some actinic keratoses may develop into squamous cell carcinoma (SCC). Who gets actinic keratoses?

Some individuals are more at risk in developing actinic keratoses, such as:

  • People with fair skin, pale-coloured eyes, red or blonde hair with a history of sunburn; and
  • Older adults

Too much exposure to ultraviolet radiation (UV) from the sun cause nearly all actinic

keratoses. UV radiation penetrates the upper layers of the skin and can cause changes to its structure and appearance.

Repeated UV exposure can also damage some of the genetic material (DNA) in skin cells causing chemical changes and mutations. It also impairs the skin’s immune system and its ability to repair any damage.

What do actinic keratoses look like?

The appearance of actinic keratoses can vary:

  • A flat or slightly raised scaly patch
  • Less than 1mm in size to over 2cm
  • Pale, red or brown in colour
  • Thickened or warty

Actinic keratoses can occur as a single, isolated lesion, but there are more often multiple. They are commonly found on areas of the body that are regularly exposed to the sun, such as the face, ears, neck, scalp, forearms, backs of hands and lower legs. They may be asymptomatic, itchy or sensitive to touch. Actinic keratoses can also affect the lips and this is known as actinic cheilitis.

How are actinic keratoses diagnosed?

Actinic keratoses are usually diagnosed clinically from their physical appearance.

In some cases, dermoscopy may be useful in diagnosing actinic keratoses. However, in cases of doubt, or if progression to SCC is suspected, a skin sample (biopsy) may be necessary.

How are actinic keratoses treated?

Treatment options will vary depending on the individual and their needs, and whether it is a single keratosis or multiple keratoses being treated.

Actinic keratoses treatment is aimed at preventing the lesions from turning into skin cancers, and improving the appearance and texture of the skin. There are many treatment options available, such as:

  • Cryotherapy using liquid nitrogen or “freezing” treatment
  • Curettage and cautery (“scraping and burning”)
  • Surgical excision (if a skin cancer is suspected)
  • Field treatments (which treat the whole affected area), such as 5-Flourouracil cream (a cytotoxic agent) +/- Calcipotriol (a Vit D analogue), Imiquimod cream (an immune-response modifier), Diclofenac gel (an anti-inflammatory), Photodynamic therapy (PDT) or laser therapy.

Pretreatment with keratolytics such as salicylic acid or topical retinoid creams may be used to help improve sun damaged skin and improve response to treatment.

What is the likely outcome of actinic keratoses?

Most actinic keratoses can be treated and cured. If they are found and treated early, they may not develop into skin cancer.

In some cases, actinic keratoses may recur months or years after treatment, and new ones are likely to develop. They are also associated with an increased risk of developing skin cancers, particularly SCC.

It is important that a combination of sun protection measures are used, including the wearing of sun protective clothing, correct use of a broad-spectrum sunscreen, wearing of a broad-brimmed hat and sunglasses to reduce the risk of developing new actinic keratoses. Oral Vitamin B3 may also reduce the number and severity of actinic keratoses

Non-melanoma skin cancers – BCC (Basal Cell Carcinoma) & SCC (Squamous Cell Carcinoma)

Key Facts:

  • There are two main types: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).
  • BCC accounts for about 70% of non-melanoma skin cancers. It begins in the lower layer of the epidermis (top, outer layer of the skin). It can appear anywhere on the body but most commonly develops on parts of the body that receive high or intermittent sun exposure (head, face, neck, shoulders and back).
  • SCC accounts for about 30% of non-melanoma skin cancers. It begins in the upper layer of the epidermis and usually appears where the skin has had most exposure to the sun (head, neck, hands, forearms and lower legs). SCC generally grows quickly over weeks or months.
  • A third group of lesions called keratinocyte dysplasias includes solar keratosis, Bowenoid keratosis and squamous cell carcinoma in-situ (Bowen’s disease/IEC). These are not invasive cancers, however may require treatment as some may develop into non-melanoma skin cancers

Basal cell carcinoma (BCC) signs and symptoms

BCC often has no symptoms and tends to grow slowly without spreading to other parts of the body.

Symptoms of BCC can include:

  • a pearly lump
  • a scaly, dry area that is shiny and pale or bright pink in colour
  • often mistaken for a pimple like lesion

Squamous cell carcinoma (SCC) signs and symptoms

Symptoms of SCC may include:

  • thickened red, scaly spot
  • rapidly growing lump
  • looks like a sore that has not healed
  • may be tender to touch

IF YOU HAVE A SORE OR PIMPLE LIKE LESION THAT DOES NOT FULLY RESOLVE OR HEAL IN 4 WEEKS OF ITS APPEARANCE YOU SHOULD GET THIS CHECK AS THE CHANCE OF IT BEING A SKIN CANCER IS HIGH

Treatment for non-melanoma skin cancer

The type of treatment depends on the type and size of the cancer and where it is located. Biopsy

THE FIRST STEP IN MOST CASES – Sometimes, all the cancer is removed with the biopsy and in this case it will be the only treatment received.

Surgery

Surgery is the most common treatment. Non-melanoma skin cancers are almost always removed (usually under a local anaesthetic) with a margin of health skin to make sure that all of the cancerous cells have been taken. In more advance cases more complex surgery maybe required under general anaesthesia in a hospital setting – occasionally additional treatment like chemotherapy or radiotherapy may be required in the most serious cases or in areas where surgery is challenging.

Other treatments

In specific cases non-melanoma cancer may also be removed by cryotherapy (using liquid nitrogen to rapidly freeze the cancer off), curettage (scraping), PDT therapy, or cautery (burning). This is in limited cases only.

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Information on PDT using natural daylight (ND- PDT with ALA 20%)

  • Typically we choose natural daylight activated – this means you will need to have 2 hours of daylight on the skin after the ALA gel has been applied by our nurse
  • We choose ND-PDT as this is typically not painful (compared to red light) and produces the best outcomes
  • PDT is a photosensitizing process that use ALA chemical which causes an oxygen free radical process to remove sun damage (actinic or solar keratosis)/early superficial BCC skin cancers.
  • If is safe and typically has very few contraindications or interactions with medications – making it suitable for the majority of patients, your doctor will have reviewed your case to be sure it is suitable for you.
  • If you develop a cold sore prior to the treatment please advise the clinic as we may not be able to proceed

On the day of the procedure:

  • Apply an untinted SPF 50 to a clean, un-moisturized, no makeup skin 30 – 60 mins prior to attending the clinic
  • If you have long hair or a fringe, please bring a headband or clips to keep hair off your face
  • Once the nurse has applied the treatment you will need to spend 2 hours in daylight – it is essentially this is a continuous period and not broken up, but the 2 hours can start once you drive home (driving time doesn’t count)
  • After the 2 hours wash the treatment off with a bland face wash and then apply a bland moisturizer

Aftercare:

  • Your skin may be quite red like you have been sunburned after the first 12hrs, this is normal.
  • Your skin will be extremely sensitive to light for up to 48 hours after treatment, SPF 50 and general sun smart care if strongly advice but you do not need to remain indoors.
  • Your skin will begin to peel within 2-4 Do not pick, peel or exfoliate the flaking skin – showering/washing the face is totally acceptable but please use a simple face wash.
  • Expect redness, peeling and occasionally Bleeding and pus are reasons to contact the practice.
  • Bland, soap-free cleansers and moisturizes such as Cetaphil cleanser and moisturiser are ideal for the first 2 weeks
  • Pain and swelling can be treated with standard pain relief
  • Avoid applying ice or cool packs but a damp cloth may be applied if there is a little swelling.
  • Your skin will begin to heal naturally within 7-14
  • Please contact the practice if you have any
  • Please book a follow up appointment 8 weeks after the PDT.

Mineral sunscreen and chemical sunscreen refer to the types of UV filters that a sunscreen uses to protect from the sun’s rays. While both protect from UVA and UVB rays, the way they protect the skin differs.

  • A mineral (or physical) sunscreen works like a sun “block”, reflecting the sun’s rays, usually has a thicker texture that leaves a cast on the skin, but starts working to protect the skin immediately.
  • A chemical sunscreen works by absorbing the sun’s rays to convert to heat and release out of the skin, are more lightweight and easy to blend, but it can take 20 minutes before it starts working.
  • Both chemical and mineral sunscreens can be broad-spectrum and protect from UVA and UVB rays, so choosing between the two is a personal preference but should

always be BROAD SPECTRUM to cover both UVA & UVB.

  • Some sunscreens are formulated to include both mineral and chemical UV filters for very high sun protection.

OUR RECOMMENDATION:

LA ROCHE ANTHELIOS

This is due to is combination of mineral and chemical sunscreen, gives high protection and typically suitable for all skin types, including those with skin conditions. Its very light to apply and comes in an anti-shine version. Most importantly it has consistently been tested (in labs across the world) to have SPF rating > 50.

COMPARING MINERAL AND CHEMICAL SUNSCREEN

 

Mineral sunscreens

Chemical sunscreens

Filter type

Reflects UV rays

Absorbs UV rays

Ingredients

Zinc oxide, titanium dioxide

Oxybenzone, avobenzone, octinoxate, and octisalate

Texture

Thicker texture. Comes in the form of cream, balm or zinc “stick”

Light-weight texture, often in the form of a cream or lotion

Appearance

Can leave a white cast on the skin and be harder to blend

Blends easily into the skin, won’t leave a white residue

Skin sensitivity

Non-irritating and suitable for sensitive skin

Some formulas can irritate sensitive skin, particularly oxybenzone

Absorption

Works immediately

Takes around 20 minutes to absorb into the skin

Shelf life

Stable with a longer shelf life

Product efficacy can degrade when exposed to the sun or improperly stored, leading to a shorter shelf life.