ASK THE DOCTOR: Precursor to skin cancer?
By DR. JIM MITTERANDO
The Patriot Ledger

Q. My doctor recently told me I had an actinic keratosis and froze it. She told me it was pre-cancerous. Should I worry? What should I do?

A. Actinic keratosis, also called solar keratosis, is a superficial, red, scaly skin patch caused by past sun damage. Actinic keratoses are benign but are considered pre-cancerous because 1 percent to 5 percent may develop into a skin cancer called squamous cell carcinoma.

Actinic keratoses are very common occurring on sun-exposed areas such as the ears, face, scalp, hands and arms. When checking your skin, look and feel for red, rough patches. If they persist for more than one month, follow up with your health care provider for evaluation.

Actinic keratoses are simply treated with freezing (called cryotherapy), which effectively burns off the abnormal skin cells with extreme cold. Cryotherapy eliminates more than 90 percent of actinic keratoses. Any remaining actinic keratosis can be re-frozen or cut off to make sure it is not a skin cancer. Freezing does cause a temporary burn injury with mild discomfort that may cause a small scar.

As you age, more of these red patches may appear. If they become numerous, freezing may not be practical and your health care provider may recommend treatments such as 5-fluorouracil cream (5-FU or Effudex), isotretinoin cream (Retin-A) or a chemical peel. These treatments can cause redness and skin irritation for several weeks.

The two most common skin cancers - basal cell and squamous cell carcinomas - also appear as red, scaly patches but are often deeper and may bleed easily. These kinds of skin cancers are easily treated with surgical excision in the office. These cancers rarely spread (metastasize) and are rarely deadly as opposed to melanoma.

Melanomas are dark, pigmented moles generally larger than a pencil eraser that may change colors, have irregular colors or irregular borders. Melanoma is the deadliest form of skin cancer that quickly metastasizes. Fortunately, they are less common than actinic keratoses, basal cell and squamous cell carcinomas.

People commonly confuse the term actinic keratosis with another benign skin patch called sebborheic keratosis. Seborrheic keratoses are dark, scaly patches that are on top of the skin as opposed to moles that are inside the skin. Seborrheic keratoses occur in most people as they age. These ‘‘barnacles’’ can sometimes bleed, get irritated, and even flake off. When bothersome, they are easily removed by freezing.

Since you had an actinic keratosis, you will need to be more vigilant about checking your skin for cancer. Actinic keratoses indicate past sun-damage and an increased risk of skin cancer. Wearing sunscreen and hats will help to prevent further skin damage.

Dr. Jim Mitterando is a family doctor at Health Care South/Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2002 The Patriot Ledger
Transmitted Tuesday, August 13, 2002