Actinic keratoses are rough, reddish patches or warty growths which appear on sun-exposed areas of the body. These growths have an estimated five to ten percent chance of turning into skin cancer called squamous cell carcinoma. Actinic keratoses that have been rough, red, irritated or tender can be destroyed by several methods. The most common method is cryosurgery (freezing). This involves liquid nitrogen which freezes skin cells causing them to die and peel off. Cryosurgery will usually destroy the precancerous actinic keratoses, but may also damage some of the surrounding skin tissue. A blister may form which may heal with some whitening of the skin and mild scarring.
Photodynamic treatment is another newer treatment used with topical Aminolevulinic Acid (5-ALA). This method involves light activation of a photosensitizer to generate highly reactive oxygen intermediaries, which ultimately cause tissue injury and necrosis. 5-ALA is applied locally and it then passes through the abnormal keratin overlying the lesion and is metabolized by the underlying cells to photosensitizing concentrations of porphyrins. The patient will be asked to return to the office within 14 to 18 hours for exposure to photoactivation of the 5-ALA in the form of a (usually blue light but sometimes a proprietary red) artificial light source for approximately 17 minutes. The patient will experience erythema, severe burning, pain and dying of the actinic keratotic lesion. Healing usually occurs in 10-14 days. However, some lesions may not respond and a second treatment session may be required after 8 weeks.
Other methods are chemical peeling agents and, rarely, removal by excision.
How should I care for the treated areas?
Wash areas gently twice daily and apply vaseline to prevent crusting. Cortisone creams may be applied the first day of treatment to reduce stinging. If treated areas develop tenderness or yellowish-infected drainage, please call the office.
What Happens After Treatment?
Often treated areas look "worse" before they look better. The area may swell or blister, can be red for days, then scale or crust and heal over one to four weeks. Wounds heal much faster if cared for as described above. Be sure to treat a blister with vaseline and band-aid or telfa pad until well healed. By one month after treatment the areas should be pink and smooth. If an area still persists with rough crusting or tenderness, it may need to be retreated or biopsied. Please make a follow-up appointment. If the treated area heals with any evidence of a thickening scar after three to six weeks please call the office for follow-up care.