Actinic keratoses (AKs) are usually flat or slightly raised scaly or rough flesh-colored or red patches that contain sun-damaged cells that are considered pre-cancerous.

This is exclusively caused by excessive sun exposure and damage.

Although the majority of AKs do not go on to become skin cancer (squamous cell carcinoma) estimates are that 2- 20% do over time.  Squamous cell cancer will need to be surgically removed, if it develops, leading to scarring.  In less than 5% of cases, this skin cancer can spread and cause death.

There are four main treatment options available:

  • Anti-cancer creams
  • Cryotherapy (freezing)
  • Electrocautery (burning)
  • Photodynamic Therapy (PDT)

Prescription anti-cancer creams such as 5-Fluorouracil (Efudex, Carac) and imiquimod (Zyclara) are highly effective, you can use them at home on your own, and they do not leave scars.  However, the affected area can be red and scaly for up to 6 weeks and can be uncomfortable.

Individually destroying each actinic keratosis by freezing it (cryotherapy) or burning it with an electric needle (electrocautery) is also highly effective. This is easy, quick, and is an in-office treatment.  Typically this scabs over for a week and may hurt temporarily. The main negatives are that this may leave white or lighter spots in their place, and this can only treat the individual spots, not a broad area, which may be better for the prevention of new lesions.

Photodynamic Therapy (PDT): treats the whole area, usually the entire face, arm, or scalp.  It improves the appearance of the skin; unsightliness is usually limited to 2-7 days such as red sunburn-like appearance, although peeling may also occur for up to a week. The advantages of this are that you are treating the entire area and this may prevent new AKs from forming. You do need to stay completely out of sunlight for 2 days following the treatment; a burning sensation may be present for the first 24 hours but occurs in less than 5% of people. At Advanced Dermatology, we specialize in PDT and are at the forefront of PDT research and innovation.