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Winnipeg Free Press - PRINT EDITION

Deal with scaly patches before you develop cancer

By: W. Gifford-Jones MD.

3/04/2009 1:00 AM | Comments: 0

I'd bet that 99 per cent of readers have never heard of actinic keratosis (AK). But thousands of people have this type of skin lesion that if left untreated can develop into skin cancer over time. Now there's a unique skin cream that can prevent or stop this from occurring.

Since the primary cause of AK is excessive exposure to the sun's ultraviolet (UV) rays, this problem is often called solar keratosis. Like an elephant, human skin never forgets all the UV radiation it gets during a lifetime. We forget the times when UV rays have bounced off snow and water, either tanning or burning our skin. And with today's thinning of the ozone layer, more ultraviolet rays are hitting the earth.

We're all at risk of excessive UV radiation and the development of actinic keratosis. But people who are fair-skinned, blond, red-headed, with blue or green eyes are particularly prone to this problem.

Actinic keratosis is normally not life-threatening provided it's diagnosed early. But five to 10 per cent of all AKs can potentially progress into squamous cell cancer. And if not treated, its lesions eventually bleed, ulcerate, become infected, enlarge and invade surrounding tissues.

Actinic keratosis is typically a reddish scaly, small rough spot that may feel sore or painful to the touch. AKs do not develop into melanoma, but patients with AKs may be prone to developing melanoma due to extensive sun damage.

Studies show that actinic keratosis has been increasing each year for the last 30 years, which means more skin cancers in the future. So look for scaly, crusty bumps on exposed surfaces such as the face, forehead, neck, hands, forearms and upper chest. Men often have AK lesions on the ear, but hairstyle usually protects women in this area.

The surface of this lesion is usually dry, rough and often feels like sandpaper. It ranges in size from a pinhead to over 2.5 centimeters (one inch) in diameter. It may be light or dark, tan, pink, red or a combination of colours. Or even the same colour as your skin.

There are several treatments for actinic keratosis. One method, cryotherapy, freezes the lesion using liquid nitrogen. This liquid is either applied by a spray or a cotton applicator and does not require anesthesia. But if excessive amounts of cryotherapy are used the skin may end up scarred and lighter in colour.

Topical creams such as Aldara (imiquimod) are also used in treating actinic keratosis. Dr. Charles Lynde, assistant professor at the University of Toronto, says "Aldara gets rid of lesions in a unique way. It stimulates and boosts the body's immune system to find and destroy potentially dangerous cells and is useful to remove large areas of AK on the scalp and forehead."

The cream is applied two times a week for 16 weeks, resulting in complete clearance of the lesion in 84 per cent of cases. But patients should see their doctor at regular intervals following treatment to make certain there are no recurrences.

The most common side-effects of Aldara are redness and itching which subside in a short time. Exposure to sunlight should be avoided or minimized when using Aldara cream due to increased sunburn susceptibility.

But prevention is always better than cure. The obvious solution is to avoid overexposure to the sun and other sources of UV light such as tanning lamps. Select shaded areas for outdoor activities, clothing with a tight weave and long-sleeved shirts and pants. Wear a wide-brimmed sun hat. And parents should teach their children to be sun-smart and use sunscreen lotion with a sun protection factor (SPF) of at least 15.

The message? Get to know your skin as this is one cancerous lesion that's easy to diagnose and treat. And if you see suspicious spots, be sure to see your doctor.

Republished from the Winnipeg Free Press print edition April 3, 2009 A19

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