Skin cancer lesions

EVERYONE looks forward to weather forecasts with bright, sunny days. However, one must be aware of the anger to the skin that is posed by spending time outdoors--sometimes with deadly consequences. Most people know that the sun can accelerate the signs of aging, such as wrinkles, fine lines, and age spots, but many are unaware of some of the hidden perils of cumulative exposure.

Excessive unprotected sun exposure can lead to skin cancer, including melanoma, which affects an estimated 44,000 Americans annually. While melanoma, the deadliest of all skin cancers, can be cured if caught early enough, there is another type that is much more common, though many individuals may not even know that they have it.

Actinic keratoses (AKs) are often invisible to the naked eye. Forty-six million Americans--one-sixth of the population--will develop an actinic keratosis during their lifetime, according to the Skin Cancer Foundation. The appearance of an actinic keratosis can be the first step in the development of skin cancer.

Although it often is referred to as a "pre-cancer," dermatologists now consider AK to be an "evolving cancer" because once skin cells become abnormal, that means cancer. This is somewhat analogous to an abnormal PAP smear in women. AKs themselves are not life-threatening, but, if let untreated, they can progress to an invasive form of skin cancer called squamous cell carcinoma.

AKs are small scaly lesions that begin under the skin's surface and then emerge as rough areas that feel like sandpaper to the touch. They can be pink, tan, red, or the same color as the skin, so they are more easily recognized by touch rather than sight. Generally, AKs range from an eighth to a quarter of an inch in size. Actinic keratoses are typically found on those parts of the body that receive the most sun exposure, such as the face, ears, lips, neck, back of hands, and forearms.

AKs usually occur in clusters, so where you notice one, it is a safe bet that there are more lurking under the surface in that same general area. This occurs because the ultraviolet damage from the sun produces a field of altered cells that become actinic keratoses.

People most at risk for this disease are those over the age of 50 who have had a significant amount of sun exposure or a history of repeated sunburns. Also vulnerable are those with fair skin, blond or red hair, and blue, green, or gray eyes. Individuals who are darker-skinned can develop actinic keratoses if they have experienced a considerable amount of sun exposure without protection. A survey by the Skin Cancer Foundation revealed that over half of men and more than one-third of women aged 65-74 who have had a high degree of lifetime sun exposure develop actinic keratoses.

Individuals also may be prime candidates for AKs if they are very active outdoors, such as golfers, tennis players, and landscapers. One phenomenon is called "left arm syndrome." It is common for those who drive a lot, such as truckers, to have many AKs on their left arm, as it is the one most exposed to the sun in American vehicles, as well as a lot of AKs on the left side of the face.

Since people may not know that they have AKs, it is suggested that a visit to a dermatologist can help them learn how to identify a potential problem. Early detection is key to receiving the proper treatment and halting the progression of AKs to a more-invasive form of squamous cell carcinoma.

Treating AKs got easier when the Food and Drug Administration approved Carac (fluorouracil cream), a once-a-day topical treatment for actinic keratoses of the face and anterior scalp. The active ingredient is the anticancer agent fluorouracil (5-FU), a form of topical chemotherapy. It mimics naturally occurring substances in the body that are essential for cell division. Rapidly dividing cells, such as those in actinic keratoses, absorb the fluorouracil, causing them to die.

Carac gives physicians a compelling reason to reconsider using 5-FU to treat actinic keratoses. Physicians and patients have shied away from previously available 5-FU therapies because they can cause heightened irritation in the treated areas that many found intolerable. There is no way to treat multiple actinic keratoses effectively with zero irritation, but with Carac, which contains just 0.5% of the active ingredient, dermatologists have an alternative that provides good clinical efficacy with a rapid recovery time. It also treats the earliest AKs before they are visible to the naked eye. Using it in combination with regular dermatologist visits for cancer screenings offers patients a significant improvement in therapy.

In addition to creams like Carac, there are some surgical techniques. Cryosurgery, which involves freezing the AK lesion with liquid nitrogen, does not require anesthesia and is relatively quick and painless.

Patients with sun damage can progress through a three- or four-step process aimed at dealing with the condition's consequences. Step one involves seeing a dermatologist to have a complete examination to exclude melanoma, squamous cell carcinoma, and/or basal cell carcinoma, all of which require dermatologic surgical intervention. Second is for the dermatologist to treat the most-evident AKs cryogenically, freezing and removing them. In the third step, Carac can be applied several weeks later to remove the remaining early AKs. Optimally, patients would progress to step four, which involves chemical peels and laser resurfacing, to improve the appearance of sun-damaged skin.

Another surgical option is curettage and electrodesiccation. With this treatment, the AK lesion is removed by scraping at it with a curette and cauterizing it with electrosurgery. This is tedious for those with many lesions.

Like Carac, diclofenac sodium gel is a topical treatment that is applied to the affected area. Duration of therapy can last as long as three months. Trichloroacetic acid chemical peels can be used to slough off the top layers of the skin. Dermabrasion eliminates the upper layers by sanding or using a fine wire brush. Laser resurfacing is a newer approach to achieve the same goal.

The best way to avoid AKs is to stay out of the sun, but that is not always possible. The next best thing is to follow careful preventive measures, such as wearing a broad-spectrum sunscreen with a sun protection factor (SPF) of 15 or greater every day, year-round. Keeping oneself covered with protective clothing--long pants, long-sleeved shirts, and broad-brimmed hats--as well as wearing UV-blocking sunglasses are also important.

In addition to yearly dermatologist exams, adults who are at risk should examine their skin from head to toe once every three months. If they note anything suspicious, they should contact their dermatologist as soon as possible.

For additional information on actinic keratosis, visit the following websites: aad.org (American Academy of Dermatology), skincancer.org (Skin Cancer Foundation), and/or aks.org (Actinic Keratosis Society).

RELATED ARTICLE: A brush with skin cancer.

Andy North was one of the top players on the Professional Golfers' Association (PGA) Tour throughout the 1970s and 1980s, winning U.S. Open Titles in 1978 and 1985. He also was a member of the 1978 World Cup and 1985 Ryder Cup teams. He has spent the last decade as a color commentator for many of ESPN's golf telecasts and currently competes on the PGA Senior Tour.

While his successes on the golf course are numerous, one of North's biggest accomplishments is not in the sporting arena--it is surviving skin cancer. In 1991, while he was eating breakfast one morning, his wife noticed that his nose looked different--a little thinner on one side than the other. She made an appointment for him with a skin cancer specialist, and North learned that he had basal cell carcinoma at the age of 40. He was lucky because they caught the disease early enough to treat it, but it still took five surgeries to remove his skin cancer.

After the surgeries, he started to see his dermatologist more frequently. North had some spots on his face and ears that he thought were just freckles or sun spots, but his dermatologist informed him that they were actinic keratoses, an early form of skin cancer that, if left untreated, can turn into a potentially fatal type.

North didn't want to go through another round of surgeries, so he and his dermatologist decided to take care of his actinic keratoses as quickly as possible. Over the years, North's physician has treated more than 20 AKs on his scalp, face, and ears.