Jason B. Amato, MD Dermatology

Overview

Actinic KeratosisAn actinic keratosis, also known as a solar keratosis, is a common premalignant skin lesion. An actinic keratosis occurs when the cells that comprise 90 percent of the epidermis, the keratinocytes, change their size, shape or organization in a process called cutaneous dysplasia.This alters the texture of the skin surface and may extend deeper, into the dermis.Causes of an Actinic KeratosisSuch a lesion is typically caused by chronic exposure to sunlight, particularly ultraviolet light and is therefore mainly found on areas of the body most frequently exposed to the sun. While not a skin cancer, an actinic keratosis, left untreated, may develop into an squamous cell carcinoma, a form of skin cancer capable of metastasizing and even resulting in death. Although not dangerous in itself, an actinic keratosis must always be taken seriously and examined and treated by a dermatologist.Symptoms of an Actinic KeratosisAn actinic keratosis appears as a scaly reddish or tan lesion on the epidermis, or surface layer of the skin. It may manifest as rough or scaly skin, bumps, mottled patterns, or protrusions called cutaneous horns. Actinic keratoses usually appear on the face, including the ears and lips, or on the neck, arms and hands.The lesions may range in size from a pinpoint to several centimeters in diameter and may be yellow, brown, red or violet in color, and smooth, wrinkled or furrowed in texture.Risk Factors for an Actinic KeratosisFair-skinned individuals, aged 40 to 50 years of age, are more prone to actinic keratosis. Nonetheless, individuals of any age may develop such lesions, particularly in warm, sunny climates. Teenagers are often diagnosed with the condition. Actinic keratosis is also more likely to occur in individuals who spend a great deal of time in the sun, or who frequent tanning parlors.Diagnosis of an Actinic KeratosisA dermatologist should always be consulted about any suspicious lesion on the skin. Unless such a lesion is immediately identifiable by the physician as benign, a surgical biopsy may be performed to determine whether it is premalignant or cancerous. The biopsy procedure is small and painless and takes place in the doctor's office. A pathology report will be available in a week or two to determine whether further treatment is necessary.Treatment of an Actinic KeratosisDepending on the location and severity of the lesion, an actinic keratosis may be treated in a number of ways. The patient and doctor will decide on methodology in consultation. These may include:Cryotherapy, or freezingCurettage, or scrapingApplication of cream or ointmentChemical peelingPhotodynamic therapy using laser lightPrevention of Actinic KeratosisBecause individuals who have had an actinic keratosis are more likely to have another lesion of this type and are also at greater risk of developing a squamous cell carcinoma, they should always opt to have full body checks with their dermatologist at regular intervals. Patients who have been treated for this condition should also avoid sunlight as much as possible. When they are exposed to the sun, they should be careful to wear adequate protection, including sunscreen with an SPF of 30 or higher, protective sunglasses, long sleeves and long pants whenever possible, and wide-brimmed hats. They should also, of course, avoid tanning parlors.Biopsy of Skin LesionsA skin lesion biopsy is a diagnostic test that involves removing a tissue sample and examining it under a microscope. This test is used to identify suspicious lesions and to differentiate normal cells from abnormal ones.Reasons for Skin Lesion BiopsiesSkin lesion biopsies are performed when simple visual examination by the physician is insufficient to make a clearcut diagnosis. Such biopsies are done in order to make a definitive diagnosis of:Skin infections which may be fungal, bacterial or viralSkin growths like moles, warts, or seborrheic keratosisPrecancerous lesions like actinic keratosisBullous pemphigoid and other blistering skin disordersDermatitis, such as eczema or psoriasisSkin cancers, including basal cell, squamous cell, and melanomaTypes of Skin Lesion BiopsiesThere are a number of different types of skin lesion biopsies, all of which are usually performed in the doctor's office. The method chosen will depend upon the appearance of the lesion or lump as well as its location and its size. An anesthetic will be applied to the skin regardless of which technique is used, and for some types of biopsy, stitches, or even skin grafts, may be required to restore the area. Most skin biopsy procedures take approximately 15 minutes to complete.Shave BiopsyA shave biopsy is the least invasive method. It involves a simple shaving, with a razor or scalpel, of cells from the upper layers of the skin, the epidermis and part of the dermis.

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