Are you developing small red rough spots on your face? If so, you may have lesions known as actinic keratosis (precancers). They are typically found on sun exposed skin: face, neck, upper chest, arms and hands. Over time, a small percentage of these lesions may develop into squamous or basal cell skin cancer.
No one is excited by the prospect of having skin cancer surgery. Thankfully, there are several different treatment options available to address actinic keratosis. The most frequently used treatment is spraying them with liquid nitrogen. While this is a very effective treatment, it is impractical if you have many lesions in a given area and runs the risk of leaving light and dark marks on the skin. Not to mention freezing is rather uncomfortable.
Instead of chasing your tail always freezing individual lesions, I encourage patients to have a field treatment of the affected areas. Several prescription creams/gels are available (efudex/carac (generic is 5-fluorouracil), aldara, solaraze, picato) which when used over a few weeks cause an inflammatory reaction that selectively targets, inflames and crusts off the precancerous lesions which are then replaced with healthy skin cells.
Another option is blue light photodynamic therapy. This treatment, typically covered by insurance, involves the application of levulan kerastick solution to the affected area in our office. After a 1-2 hour incubation period, we place you in a light box for 16 minutes which activates the solution and targets the precancers. Most patients note a stinging sensation on the skin during the treatment, but tolerate it well. After the treatment, your skin appears red, like a mild to moderate sunburn. Over the next 7 days the redness and flaking subsides. Typically two treatments are performed about 4 weeks apart. Patients tend to prefer this treatment over prescription creams because it is typically associated with a less severe skin reaction and fully heals within one week of treatment. The one caveat with this treatment is that you must remain indoors for 36 hours after your treatment as the levulan solution will make you very sensitive to sunlight for this time period.
Laser skin resurfacing with our Ultraplulse CO2 laser is another option that will address not only actinic keratosis lesions, but also sun spots, poor skin texture and fine lines. This, however, is not covered by insurance and is considered a cosmetic procedure.
Preventative measures include zinc/titanium containing sun screen, UPF protective clothing, hats and a retinoid cream in the evenings. Also, attempting to exercise or do other outdoor activities early or later in the day can greatly reduce your sun exposure and risk of developing actinic keratosis and skin cancers.